Meta-analysis finds statins effective in older population

Statin therapy reduces the risk of major cardiovascular events across all age ranges, even among people older than 75, according to a meta-analysis published in The Lancet.

The cholesterol-lowering drugs are less frequently used in elderly populations, due both to limited evidence of efficacy in clinical trials—which often contain low numbers of individuals over 75—as well as lower rates of adherence among older patients. There are also concerns that older individuals may be more prone to experiencing medication-related adverse effects, particularly if they have other comorbidities and are taking several other drugs.

To better assess the effectiveness of statins in older populations, researchers with the Cholesterol Treatment Trialists’ Collaboration pooled patient-level data from 28 randomized controlled trials encompassing 186,854 patients, nearly 15,000 of whom were older than 75.

Across all participants, statin therapy or more intensive statin regimens decreased by 21 percent the risk of major vascular events including MI, stroke, coronary revascularization or death from coronary heart disease (CHD) for each 1 mmol/L drop in LDL cholesterol. For major coronary events, including MI or CHD death, the relative risk reduction per 1 mmol/L decrease in LDL cholesterol ranged from 30 percent in those younger than 55 to 20 percent in those age 75 and older.

However, the authors pointed out older individuals have a higher event rate, so smaller proportional declines in risk might lead to a similar number of actual events prevented.

Importantly, deaths from cancer or non-vascular causes weren’t higher among older statin users versus non-users, suggesting the CVD mortality benefit didn’t come with a tradeoff.

“There is a paucity of information on the effects of statins on mortality in people at low risk of vascular disease, and very large trials … would be needed to provide direct evidence of a mortality reduction among older people in primary prevention,” the authors wrote. “However, our overall analyses in a combined primary and secondary prevention population indicate that the proportional reductions in vascular mortality are similar irrespective of age.”

The researchers noted the reductions in event rates appeared to be smaller in the primary prevention patients versus those taking statins for secondary prevention, but there were so few older, primary prevention patients that more investigations are warranted.

A recent study of long-term care facility residents older than 75 concluded they experienced similar risks of mortality and cardiovascular hospitalizations with intensive or more moderate doses of statins. But those patients may substantially differ from community-dwelling older adults such as the ones included in the Lancet meta-analysis.  

“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,” Bernard M.Y. Cheung, PhD, and Karen S.L. Lam, MD, wrote in a related editorial. “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."