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NICE to review primary prevention advice as study finds statins ineffective in elderly

NICE will review recommendations that GPs should prescribe statins to prevent cardiovascular events in patients over 75 for primary prevention.

This comes after new research found that statins did not effectively reduce the risk of heart attacks or stroke in older patients, unless they had diabetes and were also under 84 years old.

These findings go against current NICE guidance, but according to NICE they form part of a ‘growing body of evidence’ which it will be considered in updated cardiovascular disease guidelines.

The study, published in the BMJ, assessed whether statin treatment is associated with a reduction in atherosclerotic cardiovascular disease and mortality in old and very old adults, with and without diabetes.

The research team from the University of Girona in Spain analysed 46,864 patients aged 75 years or older without clinically recognised atherosclerotic CVD, from 2006 to 2015, using the Catalan primary care system.

They found that statins were not linked with a reduction in the risk of cardiovascular events in healthy patients over 75 years old, despite the risk being ‘significantly higher’ in this group than the risk thresholds proposed for statin use in NICE guidelines.

However, in patients with diabetes, researchers saw that statins reduced the incidence of atherosclerotic CVD by 24%, and all-cause mortality by 16%, in participants aged 75-84 years.

Although no benefit was seen in type 2 diabetes patients aged 85 years or older.

The paper said: ‘These results do not support the widespread use of statins in old and very old populations, but they do support statin treatment in selected people such as those aged 75-84 years with type 2 diabetes.’

Under current NICE guidelines, GPs are advised to ‘consider people aged 85 or older to be at increased risk of CVD because of age alone’, and to offer statins for primary prevention of CVD in patients who have a 10% or greater 10-year risk of developing CVD.

The guidance also advises GPs to consider statins for over 85s as they ‘may be of benefit in reducing the risk of non-fatal myocardial infarction’.

Following the latest findings, NICE director for guidelines Professor Mark Baker told Pulse: ‘There is a growing body of evidence in this area which we acknowledge needs to be looked at in an update of our “cardiovascular disease: risk assessment and reduction, including lipid modification” guideline and preparations are being made to do this. This BMJ study will form part of that update.’

Nearly 12m people in England would be taking statins if GPs followed NICE guidelines in full, researchers said last year, after the QRISK2 threshold for prescribing was lowered from 20% to 10%.

GPs have previously warned that elderly patients are being overtreated, with many saying that this is the result of patients are being treated using risk factors rather than symptoms.

What the study found 

  • In patients without diabetes or cardiovascular disease (CVD), taking statins did not reduce the risk of CVD events or all-cause mortality in those over 75;
  • In patients with diabetes, statins showed a protective effect against CVD, but this began to lose significance at age 85 years and definitively disappeared by the age of 92;
  • Following current NICE guidelines, most of the population in this study would be suitable for statin prescriptions, as the incidence of CVD in the control group was well above the recommended risk threshold of 10%;
  • But as statins were only protective in those with type 2 diabetes under 85 years, the results do not support NICE recommendations in old and very old people without diabetes.

Source: BMJ