17 February 2021

New evidence on statins in the ‘oldest old’

Cardio Clinical Neurology

Starting and continuing statins in the “oldest old” after an ischaemic stroke appears worthwhile as new research shows they significantly reduce early death and cardiac events.

To date, many elderly patients had been missing out on this potentially life-saving medication, the authors suggested as evidence of benefit in this age group was scarce.

A team of Dutch scientists drew on a database of patients from almost 700 general practices in the UK, linked to databases on hospital episodes and national statistics.

Almost 6,000 people aged 65 and over, of whom about half were 80 or over, had been hospitalised for a first ischaemic stroke between January 1999 and February 2016.  

The patients had no prior history of stroke or myocardial infarction, or statin prescriptions in the year before they were discharged from hospital following their stroke.  

The authors found that nonfatal myocardial infarction, nonfatal stroke and cardiovascular mortality were lower among the over-80s who were started on statins and continued taking them for at least two years, compared to their peers who weren’t prescribed statins. These findings mirror those found in the 65 to 80 age group.

Compared with no statin prescription, one to two years of statins also significantly lowered the all-cause mortality risk in both groups.

Current guidelines give limited recommendations on the initiation and discontinuation of statin treatment in older patients, but the authors said their findings provided evidence for initiation in this age group to prevent cardiovascular disease recurrence after a first stroke.

“Although prescription rates increase over time, in our study up to 40% of the patients aged 80 years and older did not receive a statin prescription within 90 days after discharge even in 2016,” the authors wrote.

“Current evidence should be better implemented in guidelines and local poststroke protocols. In case of a positive decision regarding initiation of statins, efforts should be made to keep patients adherent to statins for at least two years regardless of a patient’s age, except when the prognosis of the patient clearly deteriorates during these two years.”

Stroke 2021, 10 February

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Marc Heyning
Marc Heyning
1 month 30 days ago

Still does not help me in the over 90’s – an ever increasing proportion of my GP practice. Statins are an easy decision in under 75s. Become more problematic in over 80s with limited life expectancies for other reasons. But, by definition, the over 90’s, even if otherwise healthy except the one ischaemic event, have a limited life expectancy. Do I add medication burden and possible side-effects at a time when it is all about quality, not quantity?