Authors of a meta-analysis research paper say statins are just as medically worthwhile in over-75s as in younger adults
New Australian research has reignited debate about statin use in the elderly, with the authors of a meta-analysis saying they are just as medically worthwhile in over-75s as in younger adults.
Scientists from Sydney and the UK analysed 28 randomised controlled trials including 200,000 patients and found that the drugs reduced vascular events at any age, with no increased risk of cancer.
“This study will provide reassurance and guidance for doctors and patients alike that people are not automatically “too old” for treatments like statins to be effective,” study author Dr Jordan Fulcher, a cardiologist and research fellow at the University of Sydney, said.
While the researchers found that the risk of a major cardiovascular event dropped by a quarter for every millimole per litre reduction in LDL cholesterol, the benefits were less sure among healthy over-75s with no history of vascular disease.
There was also no support for their routine use in older people with heart failure or on dialysis.
While the evidence supporting statin therapy as primary prevention in the elderly was more modest, those with a high absolute risk of cardiovascular disease would still be likely to benefit, Dr David Sullivan, head of chemical pathology at the Royal Prince Alfred Hospital, said.
Given an estimated two in three Australians in the over-75 age group are taking at least five medications, statin use for primary prevention evokes concerns about polypharmacy.
Because only 14,500 of the study population were older than 75, Australian researchers are currently undertaking more research to determine the benefits of statins for primary prevention specifically in this group.
Emeritus Professor Mark Wahlqvist, former head of medicine at Prince Henry’s Hospital and Monash Medical Centre, said the report was “disturbing” for its lack of acknowledgement of the non-statin approaches proven to improve disability-adjusted life expectancy.
“After tobacco, regular physical activity and biodiverse food patterns, [for example, the] Mediterranean diet and its counterparts in other food cultures, are most valuable,” Professor Wahlqvist told The Medical Republic.
One of the most important factors in healthy ageing was access to nature and public open spaces, and another was social networks, he said.
Unfortunately, these non-drug approaches were often ignored and lacked funding for randomised controlled trials, he added.
It was also concerning that the report ignored the health profile contexts of the original research, he said.
“Statins are a risk factor for diabetes, [which is] increasing globally, and a risk factor for much disability, notably neurodegenerative disease,” he added.
Lancet 2019; online
2 February
