an older woman taking pills

The American Heart Association (AHA) and the American College of Cardiology (ACC) created a risk calculator that tells physicians and patients when someone should take a statin-type cholesterol-lowering drug. Men in very good health will be told they need statins if they are over 64. You could be a vegetarian, run 5 miles daily, have blood pressure readings of 120/80, total cholesterol of 170, HDL cholesterol of 65 and no diabetes. The ACC/AHA says you need statins anyway! If you are a woman in equally good health and over 70, you too will be told:

“On the basis of your age and calculated risk for heart disease or stroke over 7.5%, the ACC/AHA guidelines suggest you should be on a moderate to high intensity statin.”

In other words, the medical establishment tells healthy older people they need statins, regardless of anything but their age. A new analysis of data from a randomized clinical trial questions that American Heart Association dogma (JAMA Internal Medicine, online, May 22, 2017).

The ALLHAT-LLT Clinical Trial Defies Conventional Wisdom

ALLHAT-LLT stands for the “Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial.” This was a carefully planned randomized clinical trial. The people who participated in this study were 65 or older. They had high blood pressure but no obvious signs of heart disease. The study ran from February 1994 until March 2002. Over 500 clinical sites recruited patients.

What They Did:

1,467 patients were randomly assigned to receive 40 mg of pravastatin (Pravachol) and 1,400 patients were randomized to usual care (UC). They were checked at 3, 6, 9 and 12 months for the first year and then every four months thereafter. The study ran for six years.

What They Found:

The subjects were surprisingly compliant. That is to say, most took their blood pressure meds and their statins throughout the clinical trial. Of those assigned to pravastatin, 86% were taking the cholesterol-lowering drug at year 2 and 78% were taking the statin at year 6.

At the end of the trial, the people assigned to pravastatin had mean LDL cholesterol levels of 109. The usual care (UC) group had mean LDL cholesterol levels of 129. Here are the results as reported in JAMA Internal Medicine (online, May 22, 2017):

“There was no benefit of pravastatin for any of the primary and secondary outcomes. For the primary outcome, all-cause mortality, more deaths occurred in the pravastatin group compared with the UC group in both age groups. For participants aged 65 to 74 years, there were 141 deaths in the pravastatin group and 130 deaths in the UC group. For participants 75 years and older, there was a nonsignificant increase in mortality in the pravastatin group, with 92 deaths vs 65 deaths in the UC group.”

The authors go on to discuss the significance of their findings:

“Our study found that newly administered statin use for primary prevention had no benefit on all-cause mortality or CHD [coronary heart disease] events compared with UC in the subset of adults 65 years and older with hypertension and moderate hypercholesterolemia in the ALLHAT-LLT. We noted a nonsignificant direction toward increased all-cause mortality with the use of pravastatin in the age group 75 years and older, but there was no significant interaction between treatment group and age. The use of statins may be producing untoward effects in the function or health of older adults that could offset any possible cardiovascular benefit.”

“Statins may have an effect on the physical or mental functioning of older adults, and studies have shown that any negative effect on function places older adults at higher risk for functional decline and death. Older adults are at increased risk for statin-induced muscle problems…”

Translating This Research into Plain English:

Here is our understanding of the ALLHAT-LLT research. Older people taking pravastatin did not live longer or have fewer heart attacks than those not assigned to the statin drug. There was actually a nonsignificant trend towards more deaths in the 75 and older group if they were assigned to pravastatin.

Another Big Study:

There are surprisingly few large clinical trials that have answered the question of whether healthy older people really do need statins. One trial called PROSPER (Prospective Study of Pravastatin in the Elderly at Risk) attempted to answer that question. Over 3,000 older adults were recruited. They did not have heart disease at the onset of the study. The authors of the JAMA Internal Medicine study noted:

“…the use of pravastatin did not result in significant reductions in CHD [coronary heart disease] or stroke events during a mean 3.2-year follow-up…the mortality rate in the PROSPER participants without CHD at baseline was 8.8% in those receiving placebo vs. 9.6% in those receiving statin therapy.”

Implications of This Research:

As already mentioned, the American Heart Association and the American College of Cardiology make it very clear that all older people need statins. If you use their risk calculator, that means healthy men over 64 need statins. So do healthy women over 70.

One study reported that 28% of people 75 to 79 were taking statins. The researchers noted that over one fifth of those older than 80 were taking statins for primary prevention (American Journal of Cardiology, Nov. 15, 2012). There is growing evidence that doctors and older patients are hopping on the statin bandwagon. In the decade between 2000 and 2012, statin use in octogenarians went from 8.8% to 34.1% (JAMA Internal Medicine, Oct. 2015). These older people had not experienced a heart attack or other vascular event.

The research we have described involves what is referred to as “primary prevention.” That means preventing heart attacks in people who have no heart disease. From these studies, it would appear that older people who have not had a heart attack, stroke or a diagnosis of heart disease do not get measurable benefit from statins.

Do they need statins nevertheless? The ACC and the AHA say yes! If you would like to better understand the recommendations of the ACC and AHA, here is an article we wrote about the risk calculator:

Will New Heart Guidelines Put You on a Statin?

An editorial in the same issue of JAMA Internal Medicine (May 22, 2017) as the report on the ALLHAT results offers a different perspective from the ACC and AHA:

“Statin therapy may be associated with a variety of musculoskeletal disorders, including myopathy, myalgias, muscle weakness, back conditions, injuries, and arthropathies [joint problems]. These disorders may be particularly problematic in older people and may contribute to physical deconditioning and frailty. Statins have also been associated with cognitive dysfunction, which may further contribute to reduced functional status, risk of falls, and disability. The combination of these multiple risks and the ALLHAT-LLT data showing that statin therapy in older adults may be associated with an increased mortality rate should be considered before prescribing or continuing statins for patients in this age category.”

We leave it to you and your physician to review the new data and determine what is best for you. There may be extenuating circumstances that call for statin therapy. If so, your physician should be able to explain them clearly.

 

Another perspective on older people and statins:

All Adults Between 66 and 75 Should Be On Statins! Really?

 

Share your thoughts and statin experience in the comment section below and please vote on this article at the top of the page.

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  1. Sara Kane
    NC
    Reply

    P.S. I do have diabetes and have lost some toes due to vascular compromise.

  2. Sara Kane
    NC
    Reply

    I would like to see more info for people who do have some cardiac history. I have had 3 stents placed in cardiac arteries for near-blockage without symptoms, and one graft in my superior femoral artery for a blood clot. I had always resisted recommendations for statins but, after these arterial problems, even though my cholesterol was normal, I did start using atorvastatin. I have been able to reduce it but still do take it simply because I am intimidated about my arterial issues.

    I do have some degree of muscle weakness but this might be due to the aftermath of all these hospitalizations.

  3. Julanne
    Reply

    I took the first drug and had muscle meltdown, the second gave me terrible migraine headaches, the third gave me weight gain. I TOLD my Dr. I was not taking any more, referring to the findings of seniors having elevated cholesterol and living longer.

  4. J N
    Seattle
    Reply

    I would like to be able to trust doctors to direct my care, but I have had a number of experiences over my long life that make me leery. I was put on a statin at age 65 (just because it would be good for me); I was quite healthy and active, but after a month or so I began having ferocious muscle and joint pains. The doctor wanted me to continue till my body got used to it; I said no when it began to feel as if my muscles were being ripped apart, quit taking statins and within a few days I felt fine again. I am 80, haven’t had a heart attack yet, and any muscle pain I have can be worked out with stretches.

  5. B.J
    Raleigh, NC
    Reply

    Both my husband and I had serious muscular problems while taking stations. Has anyone tried Repatha and had good results (lowering of LDL) from it?

  6. Judy
    Florida
    Reply

    I urge everyone to read the book The Great Cholesterol Myth written by Stephen Sinatra, MD and Jonny Bowden, Ph.D. You will have a greater understanding of how the Medical world got on the cholesterol bandwagon and why lowering cholesterol will not prevent heart disease. They give a statin-free plan that will help in preventing heart disease. I really think the book is an eye opener and only in rare instances do they feel someone should take statins.
    Also, they said sugar not fat was the demon in the diet. Something that has been in the news lately and they were saying it back in 2012 when they wrote the book.

  7. Robert
    Cary, NC
    Reply

    I was on statins three times — different meds and dosages. In all cases the result was horrible. I never had such awful pain. Since the statins were not tolerated, my doctor put me on Zetia. Is there any analysis, similar to this article, on the pros and cons of Zetia?

  8. Tim
    S Dakota
    Reply

    A cardiologist tried several different statins to treat my cholesterol. That was over a period of one year’s time. I could not tolerate any starin because each one gave me extreme leg pains to where I could barely walk. I’ve been off all statins for over a year but I still have residual effects. Statins = Poison.

  9. Jim
    Florida
    Reply

    So, the American Congress of Crackpot Cardiologists continues to badger people about statin-poisons, whether we need them or not. This activity should be criminalized immediately. Mr statin -pusher gave me type 2 diabetes and parkinsonism with his dirty piils. He should be put out of business for his messianic pushing of statins – the sooner, the better.

  10. Virginia
    Reply

    I am now 69 ,have genetically elevated cholesterol, and have tried EVERY statin out there, and could not tolerate any of them,even the rx fish oil. I decided to risk the unknown possibility of some CVA versus the known suffering from statins. So far it has been the right decision for me.

  11. Lynn
    Illinois
    Reply

    My father was significantly harmed by taking statins. In the last several years of his life doctors kept trying to drive down his cholesterol with statins, and he developed muscle and joint pain so bad he stopped exercising and became increasingly frail. He also developed dementia. I tried to get him to stop, but he was of the generation that did not question a doctor’s advice. There is no way I would take those drugs, even if I did have risk factors or indicators for heart disease–the side effects are just too devastating.

    I too believe the way they are prescribed under the new guidelines is either a scam or a medical fad or both. I’m glad the People’s Pharmacy is helping to unmask this situation, and I hope people will learn to question their doctors’ advice instead of just going like sheep to the slaughter.

  12. Pete
    Chicago
    Reply

    This is nothing new. Study after study shows this stuff is no good. Drug companies make billions. with the help of these organization. Do they think we’re stupid. ARE WE STUPID. How could ANYTHING that the AHA or ACC be taking seriously from this point on.

  13. ariel
    usa
    Reply

    I ägree! My Endocronologist says if the good cholesterol level is high, I do not need cholesterol meds. I went to another Endo once because I did not feel like driving the long drive to my regular dr.
    Yep! he said I needed statins. My good End of 15 yrs told me on the next visit that there WAS a second test that that dr should have done to see if I needed statins, which the dr did not do.

    also that dr told me to take aspirin for heart. My Endo says I do not need it.

    anyway just wanted to share my experience on this.

  14. Carol S
    Reply

    Years ago I had some heart palpitations when going to a high altitude location. When I visited a cardiologist (electro-physiologist type), he said he recommended statins to me. I declined. His response was, “If you won’t take a statin, will you at least take fish oil?” I said “sure!” I began to take fish oil, and it stopped the palpitation problem!

    I didn’t want to take statins, because of the dangerous side effects of statins, such as destruction of muscles, resulting in kidney damage or kidney shutdown. This muscle destruction by statins is known as rhabdomyolysis, and includes a lot of muscle pain and kidney damage!

  15. Brooke
    Mn
    Reply

    I decide what meds I take.I will never take a statin.

  16. Garry TM
    Reply

    Within 48 hours of beginning simvastatin I experienced violent and painful leg spasms. The pain gradually subsided after 2 or 3 months but the spasms continued for the better part of a year.

    I have no doubt that the drive on the part of the medical industry to promote statins for all is a scam. Some people, particularly some younger men need help to lower cholesterol. But it has been demonstrated that, for most, making use of a heavily plant based diet will begin clearing arteries of excess cholesterol and calcium in a matter of weeks.

    Cholesterol is a positive good. Every cell in our body is composed largely of cholesterol including the brain. Studies confirm that seniors with “high” cholesterol outlive those with “normal” or low cholesterol.

    While thousands of good dedicated people work in the pharmaceutical industry, the upper management frequently engage in criminal activities which have resulted in the deaths of many. Their companies-not the individuals- pay billions in fines for these deeds but jail time is not applied. There is simply too much wealth and political control to achieve justice.

  17. Kathleen P
    Garland, Tx
    Reply

    I recently turned 65 and will not take any statins. I have seen the negative side effects these drugs have caused in my husband. I am not over weight, I workout 6 days a week, and my blood pressure and cholesterol levels are within normal limits. Less in more in terms of the drugs I put in my body.

  18. Rita Nakashima Brock
    CA
    Reply

    I was put on statins about a year ago, though I’d had a thorough cardiologist exam about 2 years ago and was fine. My cholesterol has always been above 200, even in my 30s, and have been a runner and downhil skier. I am now 67, walk 12-15 miles a week and do weight work in the gym twice a week.

    After a few months on the statins, my immune system was a wreck. I usually have a cold 2X a yr for 2 days. I got one that lasted 10 days, turned into bronchitis (I’ve never had this happen before), and then on the heels of that stomach flu that lingered a week. I stopped taking them after that. I’ve been fine since, not even a sniffle.

  19. CJ
    Indiana
    Reply

    An ounce of prevention is worth a pound of cure, sure, but why take medication for a condition that one does not actually have? It seems that senior citizens take so much medication, why add one that’s not needed and could actually cause problems?

  20. Jerry
    NC
    Reply

    My husband has been on statins since 1987 because his cholesterol reading was 300 at that time. He is 76 and has developed dementia and his muscles have deteriorated significantly. No one in his family has a history of dementia…I feel that this long-term use of statins has contributed to his medical issues, but we cannot get any of his doctors to agree to take him off the medication. They have finally lowered his dosage to 5 mg of Crestor. We don’t want to go against the advice of the physician and probably at this point, it would not reverse his symptoms.

    • Claude
      Salisbury NC
      Reply

      There are too many drugs that are poison to us less you take the better off you are! I would not knowing take a Stain

  21. Bill
    North Raleigh
    Reply

    This is a potentially explosive article. As a 67-year old, I have been taught that statins are fundamental to good health. My personal physician certainly believes so. If anything, he’d like to increase my daily 40MG pravastatin dosage. Because of your article, I’m not so sure. In fact, I’m a bit confused. I wonder if it’s time for a second opinion? I also wonder how much pushback you’ll receive from the “medical establishment.”

  22. Karen
    Chapel Hill, NC
    Reply

    I discovered that it was the Lipitor I was taking that caused my brain fog when I went off it to see if it was responsible for my complete loss of my sense of taste. It was. My sense of taste came back within a few weeks, and I will never take another statin again.

  23. Mary
    Florida
    Reply

    My body does not react to medication well. Prescription pain relievers give me migraine headaches. Ambien kept me awake for 3 days (the doctor said I was in pain because I was sleep deprived – maybe I was sleep deprived because I was in pain???). Statins caused the muscle and joint pains, and my doctor still insists on discussing statins as he tries to talk me into taking them. I am as active as I can be with the joint and muscle issues. My diet is better than most (dietician asked if she could share my diet with other patients to prove to them it can be done). My blood pressure is normal to low/normal. I am about 20 pounds over optimal weight but it’s hard to lose when my mobility is limited. I get out and try to enjoy life and every single appointment with my PCP is a debate over statins. Without switching doctors, I don’t know how to get him to stop pushing them even though I have told him repeatedly it is not something I want to do. Any suggestions?

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