The People's Perspective on Medicine

Statins for Older People | A New Study is Wildly Misinterpreted!

Should doctors be prescribing statins for all older people? A new meta-analysis has been interpreted that way. Read the full story here. We share the data!

The headlines this week have been emphatic: “Study: Proof Statins Help Older People.” Then there was this one: “Cholesterol Lowering Drugs Giving Older Adults Better Heart Health.” We were intrigued by the headline: “All over 75s Should Be Offered Statins but ‘Ageism’ is Failing Patients.” One might conclude that any doctor who doesn’t prescribe statins for older people is ageist. The gist of most of these headlines is that health professionals must be prescribing statins for older people regardless of their risk factors. The statin enthusiasm stems from a meta-analysis published in The Lancet (Feb. 2, 2019) Does the evidence support the hype?

Do Journalists Actually Read the Research They Report On?

We have long worried that many journalists barely read the abstract or the summary of the medical research they write about. We suspect that they do not dig into the data in any meaningful way.

Here is what the health editor wrote in The Guardian (Jan. 31, 2019) under the headline

“‘Fake News and Ageism’ Keeping Statins from Older People”

“Thousands of deaths and the wrecking of many lives by disability could be averted if doctors routinely offered a daily statin pill to older people, scientists say.”

This makes it seem that if doctors don’t prescribe statins for older people, many are destined to die prematurely or experience a life with disability. Let’s see if the data support that conclusion.

Do Statins for Older People Help Prevent Heart Attacks?

The Cholesterol Treatment Trialists’ Collaboration has done a meta-analysis of randomized controlled trials comparing statins to placebo. About 8% of the volunteers in the 28 trials analyzed were over 75 at the beginning of their studies. They were followed up for approximately five years.

You can tell that the clinical trials, mostly sponsored by drug companies, did not actively recruit older people. Only 8% of the subjects qualified as elderly.

Statins for Older People Did Help…If the Risk Was High.

The older people in the study who had clearly diagnosed heart disease did benefit from statins. Among such volunteers over 75 years of age, 6% taking statins had a major vascular event compared to 7.3% on placebo. That’s something, but hardly a barn burner.

In actual numbers, there were 528 “events” in the over-75 statin-taking group with vascular disease. That’s out of 8,034 people. Among the 6,449 older people with vascular disease on placebo there were 606 events. That sounds really impressive if you call it a 26% relative risk reduction. The absolute risk reduction is 1.3% in people at high risk from existing heart disease.

Statins for Older People at Low Risk?

In the group of older people without heart disease, however, the absolute difference between statin and control groups was only 0.1%. That was not statistically significant.

Put another way, older people without diagnosed heart disease got little, if any, benefit from taking drugs like atorvastatin, pravastatin, rosuvastatin or simvastatin. The headlines did not make a distinction between older people with heart disease and those who were not at high risk. Many of the news stories made it seem as if doctors should prescribe statins for older people regardless of risk.

The Heart Risk Calculator:

Many primary care physicians rely upon the American Heart Association (AHA) and the American College of Cardiology (ACC) to provide guidance when it comes to prescribing statins for older people. The Heart Risk Calculator from the AHA and the ACC advises health professionals and patients to consider adding a statin based primarily upon age once a man is over 64 and a woman is over 67

That’s even if cholesterol levels and blood pressure numbers are perfectly normal. An older person could be running 10 miles a day and eating mostly vegetarian fare and the AHA would still recommend a statin.  If our analysis of the data in the new study (Lancet, Feb. 2, 2019) is correct, there is little, if any, benefit in prescribing statins for this healthy group of older individuals.

Other research has not been as enthusiastic about statins for older people. Here is a study published in a competing journal (The BMJ, Sept. 5, 2018). Should you wish to read our overview of this research, here is a link

Statins Fail to Help Healthy Older People

Another study published in JAMA Internal Medicine (online, Jan. 22, 2018) also questioned the benefits of statins for older people. You can read our analysis of that study at this link

Are You Confused Yet?

It would be amazing if you weren’t totally confused. The research published in The Lancet was widely interpreted as a green light to prescribe statins for older people…all older people! If you read the newspaper headlines, you might believe that healthy people who didn’t take statins were risking disability or early death. And yet we have just offered research in reputable journals that contradicts that conclusion.

We apologize for muddying the waters. We always encourage you to ask your doctor about absolute risk reduction. How many people out of 100 will benefit from any given treatment? Another way to ask the question is this: doctor, what is the number needed to treat (NNT)?

In other words, how many people would have to take this medicine for one to get a meaningful benefit? If that number is more than 80 or 100, it might not be worth the risk. If only five or six people need to take a medicine for one to get a good outcome, that is a slam dunk winner!

And always ask about side effects. Here is a link to the most likely complications from statins:

 Listen to a free statin standoff interview with both a statin enthusiast and a statin skeptic at this link. Here is a cardiologist who questions the cholesterol hypothesis. You can listen to Dr. Dubroff’s perspective at this link

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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I’m a 57-year-old woman who exercises regularly, eats well (mostly vegetarian), and generally takes care of myself. I am on no prescription medication. I’ve known since my mid-20s that I have high total cholesterol (over 200, though not much). My HDH, LDL, and triglyceride numbers have always been good. Here’s a conversation I had with my FORMER doctor:
HIM: You need to be on statins.
ME: But what about the potential side effects, severe muscle pain, cataracts?
HIM: What’s a little muscle pain when compared to heart disease?
ME: Nothing, I guess, if you’re not the one having it.
HIM: C’mon, be a good patient.
My thought, though I didn’t say it, was: “You be a good doctor.”
Needless to say, I found another doctor who thinks my numbers are fine when viewed along with my lifestyle.

My husband, healthy, not overweight, and very active, had a major heart attack at 71. He had had a complete heart workup with nuclear stress test, etc., 6 months prior with no abnormalities, indications, or recommendations from the Cardiologist. At the time his only meds were, 1 low- dose aspirin daily, red yeast rice, and niacin (both over-the-counte ) for slightly elevated cholesterol (cholesterol was lowered as a result). Tests were ordered because of a heart murmur (long term).

Immediately after the heart attack he was given prescriptions for: 80 mg atorvastatin daily; metoprolol 25 mg daily; clopidogrel daily; plavix,and baby aspirin. We were told this was “standard” after a heart attack regardless of the patient’s health, test levels, weight, or lifestyle prior to the attack.

Of course, going from no prescription meds to all these at once was difficult. The side effects were multiple. Our internist suggested lowering the statin drug to 1 pill twice a week after first taking 500 mg (prescription strength ) daily for 2 weeks; then twice weekly along with the atorvastatin (twice weekly). This greatly reduced the side effects from the statin.
Hope to get off the drugs (it has been 16 months ) but cardiologist acts as if he’ll need them forever.

Thought you might research or shed light on this treatment to reduce side effects of statins and comment about standard treatment after a major heart event — and length of time necessary or beneficial according to current research.
Thank you !

I, too, had problems with statin drugs and now have chronic neuropathy in one leg. After stopping, this neuropathy began to improve, but my cholesterol appears to have a rebound effect, with an increase to a point much higher than I had previously. I have now been using Repatha, which has had a dramatic effect on the cholesterol, which is now lower than it has ever been, without statins. However, the neuropathy in my leg has again increased, along with pain and difficulty sleeping at night. I have discussed with my doctors that I believe that cholesterol is necessary and a symptom of an underlying issue that our bodies produce cholesterol to fight. Is there any evidence that my theory is correct, and I should be taking a different approach?

First off, the results of the study are very unimpressive and, given the side effects of statins, why would anyone willingly take them? Also of note, the study in your synopsis only looked at the occurrence of vascular events and did not look at other events. What about the quality of life of statin vs non-statin user. Or what about all-cause mortality in the study?

Thanks for the review of the article. It is with trepidation that I would take statins should I need them.

Inflammation is the cause of clogged arteries not cholesterol. Your body will use cholesterol in an attempt to repair fissures in artery walls caused by inflammation. Over time, of course, it accumulates & can cause a blockage. The solution is to reduce or eliminate inflammation. Statins can reduce cholesterol but do nothing to address the underlying problem. Statins deplete COQ10 levels which is what causes the muscle pain so many experience. Additionally statins starve the brain’s neurotransmitters of cholesterol which is necessary for them to function properly. Sugar, refined carbs & chemical additives in food all contribute to inflammation & should be eliminated from the diet. As to calcification, this is primarily caused by inadequate levels of vitamin K2 which is needed by the body to absorb calcium. If the calcium is not absorbed it, too, accumulates in arteries. Statins should only be used as a last resort to prevent a heart attack in a high risk case.

After researching the statin my dr wanted me to take for chlorestrol it had side effects of longtime use leading to dementia and Alzheimer’s, I refused to take it. I am searching other means to lower my chlorestrol

Try the supplement Bergamot,(European citrus) found in Health Food Stores and online. Have been taking it and CoQ10 for 6 months plus and hope to see decrease in my chlorestrol next week. Stopped taking atorvastatin 3 months ago after depilitating leg/muscle pain, difficaulty walking at times; and pharmacist recommended to stop. Had to stop all physical activities due to pain.

I have a doctor who wanted to put me on a statin and I refused. I am seventy four years old with high cholesterol and I have opted to instead take niacin, flaxseed oil, CoQ10. red yeast rice and magnesium these are all natural statins. The doctor will retest for cholesterol after four months. At my age I am not on any prescription drugs and refuse to do so because of all the side effects that they have. Also having read that most people as they age their cholesterol levels and blood pressure goes up then maybe this is natural, after all just how long can we force our bodies to continue going on all these drugs with all the side effects each one has. I know to many older adults who are taking at least seven prescriptions and quite a few who are taking a lot more than that.

If one has very high cholesterol you might first try Red Yeast Rice, the natural product from which statins are derived. Cheaper and safer but may cause the same muscle pain that statins often do.
My wife tried both but had he same muscle pain with each of them. I just turned 80 and have taken NO prescription drugs for the past eight years. I do take many supplement though and so am enjoying excellent health. I’ve had much better care from my naturopathic doctor than an MD.

My grandfather died 4 months before his 97th birthday in 2004. Prostate cancer was found just over 2 years before his death. Unless he was injured, he never went to a doctor that I knew of. Even after the cancer was found, they only put him on a blood pressure pill and hormone shots. No diabetes or cholesterol meds. He ate whatever he wanted which included bacon and eggs almost every day of his life.
I resisted taking statins but gave in after years of trying to control it with diet, took it about 15 years at least. 2017 I weaned myself off of it. There is more info and studies on what it does and/or doesn’t do that’s negative to people. At 66 I don’t have diabetes or high blood pressure and cholesterol is good for your brain. Your brain uses 25% of what’s in your body. I’ll bet lowering cholesterol is the cause of a lot of alzheimer patients in MY opinion. It seems to me the percentage of people with dementia/alzheimer’s wasn’t as prevalent over 30 or 40 years ago as it is now since the wide spread use of statins. I could say more but you get the idea.

Could Joe and Terri clarify what exactly is “diagnosed cardiovascular disease”? High cholesterol? High blood pressure? Or having already experienced a cardiovascular event?

I knew a doctor here in Dallas who, back in the 1980’s, was part of a panel that wanted to put
statins in our nation’s drinking water.

My husband was given statins which caused permanent memory loss, terrible pain, and may
have triggered peripheral neuropathy. He does not take statins, but at age 80, he has had
two stents put in, takes 8 prescription drugs for prostate, neuropathy, and heart. This is
not good.

statins are not without side effects and risks

“Muddying the water” indeed! Every week some new quack idea hits the news. Simply stated (by me, a non-medical person), no single therapy is right for 100% of the population.

I suffered severe leg and abdominal pain from a variety of statins and anti-cholesterol drugs over a period of months. My doctor, whom I respect highly, said that I probably would be better off without the drugs, as my cholesterol numbers were borderline to begin with, even though he takes them himself due to a family history of high cholesterol.

It is even possible that the brief exposure to these drugs permanently worsened a muscle problem in my legs.

At 87, it’s hard to tell what works and what doesn’t, but, as I don’t expect to live forever (in this life, anyway), one pill a day, more or less, is unlikely to change things.

I would fire any doctor that attempted to order a statin drug for me.

I did.

Never believe any medical articles trumpeted by the media without examining the underlying studies yourself and doing your own research. the vast majority of journalists, especially those under 50, have no science or math background whatsoever. Their primary purpose is to write clickbait stories that will enhance their employer’s revenue by appealing to readers’ emotions—primarily fear. No wonder so many people take anti anxiety medications!

Do your own research using reputable websites, including the Peoples Pharmacy—not alarmist blogs. get copies of all test results and look up terms. Bookmark websites that explain what abnormal blood values mean. Do not be afraid to question prevailing medical dogma e.g. that you must use sunscreen, that fat in food is bad for you, etc. If your doctor is too busy to answer your questions, or if you are met with condescension or annoyance, Find a better doctor. There are many good doctors out there. You have the right to do your own research and to advocate for yourself. When interfacing with medical personnel, always be polite—but persistent.

The same is true hen dealing with veterinarians. Pets need us to advocate for them because they cant do it themselves. Your pets will thank you for it.

A great book on interpreting statistics and detecting misleading statistics (like those quoted above) is “How Not to be Wrong: The Power of Mathematical Thinking” by Jordan Ellenberg. It’s not heavy on the math, easy reading.

also, the classic “how to lie with statistics” by darrell huff. not a hard read, and guaranteed to make a statistical skeptic out of anyone who reads it.

I’m 73 with no history or risk factors for cardiovascular disease. At my annual doctor’s visit this week, my doc again advised me to start a statin, which I have resisted thus far. I have good lipid values, take regular exercise and consume a very healthy diet. Thus, this paper and your comments were of special interest.

I got the paper and studied it carefully in light of your comments, reaching the same conclusions as you did – recommending statin therapy to healthy seniors is not supported by the data. Thank you for correcting the poor reporting in the general media. Hopefully my doctor is reading your evaluation, not the Guardian.

I’m sure it’s no accident it was reported the way it was. I think big drug companies have virtually no regard for anything other than money and any trials they run should be highly suspect. They prove over and over that they are willing to lie about results.
I really would like to know how many drugs all the drug company execs. take. I suspect damn few as they are full well aware of the less than impressive benefits of many drugs as well as the underreported and minimized side effects.

All the drug companies make statins. All the drug companies want to make profits. Therefore, all the drug companies will promote statins and push doctors towards giving them to everyone. Like never owning an Apple product, I will hold out and not take statins. And do I trust today’s media and the drug testing process? Nope.

I’m grateful that you’ve kept harping about statins. My husband turned 60, and the doctor wanted to put him on statins! His mother had bypass surgery, so that was the criteria. I argued against it, and thought I’d won until he saw another doctor last year, who finally talked him into taking statins. I kept sending my husband your articles, telling him I wanted him to stop. His cholesterol had been great, and so was his blood pressure (pre statin).

He did stop without any problems (I just saw that he shouldn’t have stopped suddenly). Anyway, he’s doing fine, and I’m relieved to have him off of them. Other than his mother’s bypass, they had no reason to put him on these drugs.

I am confused.. I was led to believe that for the elderly, a Statin was not good for the brain. My doctor took me off of them at age 82..

I am a healthy senior, 84 this month. I had a major heart attack 21 Years ago, 3 stents inserted and have been doing well ever since. Of course I was prescribed statins and took 3 or 4 different kinds over the next 12 years. After a period of time each one started to cause muscle problems in my legs. When taking statins my total cholesterol was lowered but the problem I always noticed was that my HDL was in the mid 30’s range which I knew was not good. Then I started taking 1500 mg of slow release niacin every day. Although my total cholesterol went up some, my HDL is now 50+! To me that is a much better result without the side effects and dangers of taking statins!

I had the misfortune to have taken high dose statins for 1 month 7 months ago and am still recovering from my ignorant self-poisoning. The best thing I suggest to anyone contemplating taking statins is to investigate what statins are and why they are being told they need them before taking them. I wish I had.

I was told I was at “high risk” and needed to start them immediately so I did, believing the medical advice without looking further into it myself! This resulted in muscle pains, brain fog, hair and nail thinning and brittleness, lethargy, pins and needles, palpitations. I could go on. Oh yes, and it cut my cholesterol to under half of what it was, my LDL to incredibley low, and I felt awful, like I was an old lady.

So I advise anyone to read Dr Malcolm Kendricks “What causes heart disease” and his reply to the Lancet article (Dr. Malcolm Kendrick | February 3, 2019 at 8:15 am | Categories: Conflicts of Interest | URL: https://wp.me/p2i0Uz-1Ni) for further clarification to this good site on why they haven’t proven its a good idea to take statins if your over 75, (or indeed if you’re under 75, a woman and much more!) . Its hard to find those who tell the truth these days as opposed to those who provide commencially profitable fake info. but call it research. I am so grateful for those individuals brave enough to risk professional suicide by being courageous enough to tell us the truth, we only have to find them and listen. Thank you The Graedons, Dr Kendrick, Dr Graveline (hs book, the statin crisis damage is a must if you are on or are thinking of taking statins), the Yusephs, and many many more. Its your body and your health, we all need to take back control and ask questions to ensure we are doing whats best for us individually and not just contributing to comp[any profits at the expense of true health.

My experience when I had a 40% block on my carotid artery was that k2 and D3 removed the block and cleared the artery over a 2-year span without any side effects like statins have.

Bob, this is interesting. What dosage levels did you take of K2 and D3?

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