Little evidence for GPs to prescribe statins in over-80s, analysis concludes

By Nigel Praities

Doubts over whether to continue prescribing statins in very elderly patients have been raised by an analysis showing little evidence of benefit in the over-80s.

The review of 12 studies – including the recent JUPITER trial - found there was 'not sufficient data' to recommend the use of lipid-lowering therapies in elderly patients, even in those with cardiovascular disease.

The analysis, published in the journal Age and Ageing this month, looked at the relationship between total cholesterol levels and all-cause mortality in the over-80s.

The studies contained nearly 4,000 patients aged 80 or over and found overall there was a ‘reverse J-curve' relationship between total cholesterol and all-cause mortality.

Low cholesterol levels (under 5.5 mmol/l) were associated with increased all-cause mortality. Some studies found intermediate levels of cholesterol (of around 6mmol/l) were associated with lower mortality, but this was not consistent across all studies. One study could not exclude that the use of statins for primary prevention of cardiovascular disease could be harmful.

The authors concluded that it was not clear whether elderly patients should continue to be treated with statins, even if they have cardiovascular disease.

Lead author Dr Line Kirkeby Petersen, research assistant at the Danish Aging Research Centre, Denmark, said: ‘It is unclear whether elderly patients should be treated for the rest of their lives when started on lipid-lowering therapy or whether the treatment has different limits at old ages.'

The findings come despite evidence from the HYVET trial that management of another cardiovascular risk factor – hypertension – is beneficial in older patients.

One of the HYVET investigators, Dr Terry McCormack, a GP in Whitby, Yorkshire, said he was not surprised by the findings and that GPs should be careful to inform patients of this.

‘One of the problems with QOF is that it doesn't take this into account and there is pressure to prescribe statins for all age groups when there is no evidence,' he said.

‘My advice is to be honest with your patient and tell them there is no evidence, and very much leave it up to the patient's discretion.'

Dr McCormack said he was currently trying to get funding for a trial of statin treatment in older patients to look at this issue in more detail.