Is statin therapy beneficial in reducing heart conditions regardless of age?
A recent study analyzed the benefits of statin therapy on reducing cardiovascular events in all age groups, including those aged 75 and older.
Statin therapy helps to lower cholesterol and is commonly prescribed to patients at risk of cardiovascular events, such as heart attacks or strokes. There is a lot of evidence demonstrating the benefits of statins in reducing the risk of cardiovascular events in a wide range of people, however, evidence on statin benefits in older people, particularly in those over the age of 75, are less clear.
In a meta-analysis summarizing a total of 28 statin therapy trials, researchers of the Cholesterol Treatment Trailists’ Collaboration published their findings on the benefits of statin therapy across all age groups in The Lancet. The researchers subdivided the patients into six age groups: 55 years or younger, 56 to 60 years, 61 to 65 years 66 to 70 years, 71 to 75 years, and older than 75 years. The median follow-up across all the trials was 4.9 years.
Statins reduced the overall risk of a cardiovascular event by 21%
The review found that statin therapy reduced the overall risk of a cardiovascular event by 21% for every 1 mmol/L reduction in LDL cholesterol levels. Among all the age groups, including patients over 75 years old, the risk reduction was similar and significant.
The overall risk reduction of coronary events was 24% for every 1 mmol/L reduction in LDL cholesterol but decreased slightly with increasing age. The overall risk of vascular-related death reduced by 12% per 1 mmol/L LDL cholesterol reduction from statin therapy, with no effect of statin therapy on deaths due to non-vascular causes or cancer. When considering all causes of death, the researchers observed a significant risk reduction with statin therapy.
The meta-analysis also examined the benefits of statin therapy in primary prevention (i.e. patients without a history of vascular disease) and in secondary prevention (i.e. patients with a history of vascular disease). Existing evidence strongly demonstrates the benefits of statin therapy in secondary prevention whereas evidence for primary prevention is lacking.
Overall lower risks in vascular-related deaths
For secondary prevention, the analysis observed lower risks with advancing age and thus a greater absolute benefit in older people. Although similar results were seen for primary prevention, the results were not as definitive because the trials had fewer older participants in the primary prevention population. Overall, when combining both the primary and secondary prevention settings, the findings showed similar proportional reductions in vascular-related death in all age groups.
Satin therapy benefits outweigh risks
The researchers maintain that the benefits of statin therapy outweigh their associated risks, such as muscle aches. They conclude that vascular events are significantly reduced with statin therapy regardless of age. Despite less robust direct evidence on statin therapy in patients over 75 years of age, the data supports its use in older patients who are at high risk of experiencing a cardiovascular event.
Written by Maggie Leung, PharmD.
References:
- Armitage, J., Baigent, C., Barnes, E., Betteridge, D. J., Blackwell, L., Blazing, M., . . . Zannad, F. (2019). Efficacy and safety of statin therapy in older people: A meta-analysis of individual participant data from 28 randomised controlled trials. The Lancet,393(10170), 407-415. doi:10.1016/s0140-6736(18)31942-1
- The Lancet: Statin therapy reduces risk of major cardiovascular events irrespective of age. (2019, January 31). Retrieved from https://www.eurekalert.org/pub_releases/2019-01/tl-tls013019.php
