Statin therapy reduces major vascular events, and a new meta-analysis shows this is the case even in patients over 75 years of age. The research, published in The Lancet, summarises evidence from 28 randomised controlled trials, including 186,854 patients, 14,483 of whom were aged over 75.
The drugs reduced risks of major vascular events by about a fifth per 1 millimole per litre reduction in LDL cholesterol. For major coronary events the overall reduction was about a quarter overall, but ranged from about 30 per cent in those under the age of 55 to around 20 per cent in those over 75. The relative risk reductions for stroke were similar in all age groups.
Statins are cholesterol lowering drugs that are widely prescribed to patients at increased risk of heart attacks or strokes. Evidence from randomised trials has shown that statin therapy reduces this risk among a wide range of individuals but there has been uncertainty about their benefits in older people.
In the past, trials that looked at the effect of statin therapy reported significant cardiovascular risk reductions in the 65-70 age group but there have been questions about their benefits in older patients, particularly those over 75. Statin therapy is often discontinued in older patients in part because of this question around risk and benefit.
The analysis focused on the effects of statin therapy on major vascular events, mortality and cancer, and the authors limited their meta-analysis to large trials, known to generate the most reliable evidence. Previous studies have shown that the benefits of statins outweigh the risk of other adverse events (such as myopathy), and ongoing work in this area is being conducted by the Cholesterol Treatment Trialists’ Collaboration.
Writing in a linked Comment, Bernard M Y Cheung of the Queen Mary Hospital at the University of Hong Kong says: ‘Even if risk reduction in people older than 75 years is less than expected, statin therapy may still be justified by a high baseline cardiovascular risk, which is usually present in older people. The present meta-analysis makes a case to reduce LDL cholesterol in people at risk of cardiovascular events regardless of age, provided that the benefits outweigh the risks and the patient accepts long term treatment.’