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Should Everyone Over 65 Take a Statin to Prevent a Heart Attack?

A new study suggests that not enough people are taking a statin to prevent a heart attack! It should be 150 million Americans. Really? Yikes!

Do statins help older people live longer? That is a question that has been controversial for decades. Tens of millions of people are currently taking a statin-type cholesterol-lowering drug every day. The American College of Cardiology (ACC) and the American Heart Association(AHA) have issued guidelines for Americans. Any man over 56 and any woman over 65 is supposed to take a statin to prevent a heart attack. That recommendation is based largely on age more than cardiovascular health. We will tell you how we concluded that in a moment. But first, some high-powered researchers report that only about a third of the people who should be taking statins are actually doing so (Annals of Internal Medicine, Dec. 5, 2023). What’s up with that?

How Many Americans Are Taking a Statin to Prevent a Heart Attack?

The numbers are extraordinary. More Americans are taking statin-type cholesterol-lowering drugs daily than almost any other category of medications. Here’s the breakdown from the most recent data we have access to:

                                         Total Rxs                   Total Patients

  • Atorvastatin    115,000,000                  27,000,000
  • Simvastatin      37,000,000                    8,500,000
  • Rosuvastatin   30,000,000                    7,400,000
  • Pravastatin       17,500,000                    4,000,000
  • Lovastatin          7,000,000                     1,600,000

Get out your calculator! That amounts to almost 50 million people! And it does not include all statins! The number could be significantly higher.

The new study in the Annals of Internal Medicine (Dec. 5, 2023) concludes that only about one third of eligible people are taking statins. The authors suggest that many more people should be taking statins to comply with guidelines from the American College of Cardiology and the American Heart Association. In other words, 150 million people should be taking a statin, according to these organizations.

Guidelines Promote Statins for Almost Everyone!

How do the guidelines create the conditions for doctors to prescribe statins to almost all their older patients, regardless of health status? It starts with the “risk calculator.” The American College of Cardiology and the American Heart Association have what they call the ASCVD Risk Estimator Plus. It allows you to put data into a “calculator” and then it will provide you (or your physician) “Advice.”

We created hypothetical healthy “subjects.” These pretend persons had no diabetes, were not being treated for hypertension and never smoked. He and she had some excellent numbers:

Systolic Blood Pressure: 118

Diastolic Blood Pressure: 65

Total Cholesterol: 160

HDL Cholesterol: 45

LDL Cholesterol: 79

The man with these numbers would be advised to take a statin after age 56. The woman with these numbers would be advised to take a statin after age 65. It would not matter if the person is a vegetarian, runs 5 miles daily and has no family history of heart disease.

The risk calculator says:

“May consider moderate intensity statin for patients with LDL 70-189 mg/dL (1.7 to 4.8 mmol/L) and presence of risk-enhancing factors.”

That is how modern medicine is encouraging 150 million Americans to take a statin!

An Analysis of SPRINT:

So…how good are the data supporting statins for almost everyone? Some doctors seem to think that statins should be put in the water supply…a little like fluoride. Let’s examine the data:

An analysis of data from the Systolic Blood Pressure Intervention Trial (SPRINT) shows that people over 65 or 70 do not appear to benefit from statin-type cholesterol-lowering medicine (JAMA Internal Medicine, online, Jan. 22, 2018). There were over 9,000 men and women recruited for the SPRINT trial. They did not have cardiovascular disease at the start of the study but they all had hypertension. Some of these patients were taking statins when they entered the study. Even though these older adults were at relatively high risk for cardiovascular events, statins did not protect them.

This analysis, published in JAMA Internal Medicine, will come as a shock to many physicians. Those health professionals who relied upon the AHA and ACC guidelines will likely be annoyed by this report. After all, experts in the cardiology community are supposed to make decisions and recommendations based on the scientific evidence. They have been advocating statins to prevent a first heart attack (primary prevention) for years.

Conclusions from SPRINT Revisited:

The author of the analysis concluded his assessment this way:

We still do not have sufficient numbers of primary prevention trials to make strong recommendations about statins in intermediate-risk populations (6%-12% 10-year risk), at least on the basis of survival. Yet even in this relatively high-risk older adult population (22%-25% 10-year risk), significant reductions in cardiovascular events were not found.

“Accordingly, until the Australian STAREE randomized trial of statin use among older adults concludes, this study lends some support to the concerns increasingly raised about benefits and harms of statins among older adults at higher risk of CVD [cardiovascular disease].”

Translating Cautious Medicalese:

The researcher who wrote that conclusion was being very careful not to contradict the cardiologists who wrote the statin guidelines for the ACC and the AHA. Nevertheless, he made it quite clear that recommending statins for primary prevention in older people is not based on solid scientific evidence.

What About Younger People?

Will taking a statin to prevent a heart attack prolong life? That is a question that almost everyone wants to know. We suspect that most health professionals believe that if they prescribe a drug like atorvastatin, lovastatin, pravastatin, rosuvastatin or simvastatin, they will add years to their patients’ lives.

An article published in the journal BMJ Open (online Sept. 24, 2015) reviewed key randomized controlled trials of statins.

Here is what the authors reported:

The survival gains we found are surprisingly small. The highest value was 27 days, found in the 4S study, achieved by 5.8 years of simvastatin therapy in participants with a history of unstable angina or myocardial infarction [heart attack].”

Perhaps even more alarming was the discovery that:

The median postponement of death for primary and secondary prevention trials were 3.2 and 4.1 days, respectively.”

When I have shared this data with caring and thoughtful physicians they tend to look at me like an alien from another planet. Such statistics contradict everything they believe to be true. Have you ever heard of confirmation bias? It is the tendency to accept that which you believe and reject that which you doubt. Just consider politics today. Confirmation bias affects health professionals even though they have been admonished to practice evidence-based medicine. Here is an article we wrote on this very topic:

Doctors Battle Over High Cholesterol and Blood Pressure

What Do Readers Say About Taking A Statin to Prevent a Heart Attack?

Jackie experienced severe statin side effects:

When my doctor insisted I start taking statins due to a family history of heart disease, I developed leg cramps and muscle weakness, balance problems (forcing me to use a cane), and intense pain down to my fingertips. My legs would give out suddenly without warning, causing me to fall down steps three times. I could not climb steps very well, either.

“My doctor switched me from one brand of statin to another, to another, at least four times. That did not help. The pain and weakness intensified. I could not walk without assistance. My doctor finally agreed to take me off statins when my husband pushed me into the office in a wheelchair.

“My muscle pain immediately subsided. But it took me over a year to be able to walk without a cane. I am on ezetimibe and fenofibrate, which my doctor assured me are not statins, but I’m beginning to wonder if they have side effects too. I have metabolic syndrome (low thyroid, diabetes, high blood pressure, obesity), osteoarthritis, gout, and kidney disease (as a result of high doses of ibuprofen prescribed to offset pain caused by statins). All except thyroid dysfunction were not diagnosed until after I turned 50.”

Gary in Buffalo, New York advocates lifestyle changes:

“In many cases, lifestyle interventions work better than medicines. Of course, there is much less profit to be made when people adopt a whole food plant-based diet and exercise more. But such a lifestyle would produce far better health improvement than taking statins. Consumers need to be better informed.”

Statins and Exercise:

Just about every health professional we have talked to over the last 40 years advocates exercise for good health. But as Jackie points out, some people have a hard time moving, let alone exercising, after taking a statin to prevent a heart attack. We fear that can be counterproductive. You may find our article on this topic of great interest:

Do Statin Side Effects Make It Harder To Exercise?

Who Benefits from Statins?

People with diagnosed heart disease do appear to benefit from statins. So do people who have had a heart attack. That is called “secondary” prevention. The goal is to prevent a second or third event from occurring. And of course no one should ever stop taking any prescribed medication, including a statin, without discussing it first with the prescribing physician.

The point of this article is to bring you up to speed on an analysis of statin-type therapy for “primary” prevention. Based on guidelines from the AHA and the ACC, tens of millions of people who do not have heart disease are being prescribed statins to prevent a first heart attack. Many of these people are “older” Americans: men over 56 and women over 65. And the primary factor driving those prescriptions is their age, not their overall health. That is what is being challenged in the research letter published in JAMA Internal Medicine. Nonetheless, researchers call for many more Americans to take statins. The findings should be discussed with an open mind by health professionals.

Please share your own statin story in the comment section below.

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About the Author
Joe Graedon is a pharmacologist who has dedicated his career to making drug information understandable to consumers. His best-selling book, The People’s Pharmacy, was published in 1976 and led to a syndicated newspaper column, syndicated public radio show and web site. In 2006, Long Island University awarded him an honorary doctorate as “one of the country's leading drug experts for the consumer.”.
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  • Kim, C.J., et al, "Trends in Primary Prevention Statin Use by Cardiovascular Risk Score From 1999 to 2018: A Repeated Cross-Sectional Study," Annals of Internal Medicine, Dec. 5, 2023, DOI: 10.7326/M23-1915
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