Statin drugs that lower cholesterol are among the most important tools cardiologists have for preventing heart disease among middle-aged patients. Until recently, however, no one knew whether drugs such as atorvastatin or simvastatin would benefit healthy older adults. A study published in The BMJ suggests that statins fail to protect these older individuals from cardiovascular complications.
How Did Scientists Find That Statins Fail in Preventing Heart Attacks for Seniors?
Investigators examined more than five years of health records for nearly 47,000 older people (The BMJ, Sept. 5, 2018). These individuals were at least 75 years old, did not have atherosclerosis and were not taking statins when the study began. Previous studies have shown that statins can help prevent repeat heart attacks in older adults. However, the researchers were specifically interested in primary prevention. In other words, can these drugs ward off an initial heart attack or stroke, especially in very old people?
They looked at people who started taking statins during the study period. To help with the analysis, they divided people into two categories: those with type 2 diabetes and those without. Nearly 8,000 of the people in the study had type 2 diabetes. During the study time frame, 7,500 of these older patients (both with and without diabetes) started taking a prescribed statin drug. Did it reduce their risk of heart problems?
Statins Fail at Reducing the Risk of Cardiovascular Disease:
The Spanish scientists report that there was no reduction in atherosclerotic heart disease or death rate among seniors taking statins. The exception was for those who had diabetes. Older people with diabetes were less likely to develop heart disease or die if they were taking a statin. That benefit held for the decade between 75 and 85 years old.
The authors conclude:
“These results do not support the widespread use of statins in old and very old populations, but they do support treatment in those with diabetes who are younger than 85 years.”
Once people with diabetes reached 85, any benefit from statins diminished and it disappeared completely in nonagenarians.
This is not the first study to show that statins fail to benefit very old individuals. An analysis published four years ago in JAMA showed that there was no good evidence supporting statin use in healthy seniors over 80 (JAMA, Sep. 17, 2014).
Do Older People Need to Lower Their High Cholesterol?
Scientists noted that people in their 70s, 80s and 90s have not been included in randomized controlled trials to test the benefits of statins. Despite the lack of evidence, there seems to be a growing trend to prescribe statins to older people.
According to the authors of the JAMA report:
“Statin use for primary prevention is also increasing among people older than 80 years, as shown in recent population-based surveys. In a large US survey, the prevalence of use was 29% in persons aged 80 to 84 years, 24% in those aged 85 to 89 years, and 14% in those older than 90 years.”
What About Side Effects?
We have worried for years that some older people get prescriptions for statin medications that may cause them distressing side effects without strong evidence that they will benefit from cholesterol control. Unless a person has diabetes or heart disease, we recommend questioning such a prescription, just to make sure that the rationale for taking the drug is solid.
Because kidney and liver function may be declining as we age, older adults might be more vulnerable to statin side effects (such as muscle pain, weakness, or cognitive difficulties) than younger people, and should be given statins only if they are clearly warranted.