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Statins don’t reduce cardiovascular disease risk in healthy older people
S
tatins are not associated with a reduction
in cardiovascular disease (CVD) or death
in healthy people aged over 75 years, finds a
recent study. However, in those with type 2
diabetes, statins were related to a reduction
in cardiovascular disease and death from
any cause up to the age of 85 years.
The results of the study, led by the
University Institute for Primary Care
Research Jordi Gol (IDIAPJGol) and Girona
Biomedical Research Institute (IDIBGI), do
not support the widespread use of statins
in old and very old people, but they do
support treatment in selected people, such
as those aged 75 to 84 years with type 2
diabetes, say the researchers.
Cardiovascular disease is the leading
cause of death globally, especially for those
aged 75 years and over. Statin prescriptions
to elderly patients have increased in recent
decades, and trial evidence supports statin
treatment for people aged 75 years or
older with existing heart disease (known as
secondary prevention).
Evidence on the effects of statins
for older people without heart disease
(known as primary prevention) is lacking,
particularly in those aged 85 years or older
and those with diabetes. So, researchers
based in Spain set out to assess whether
statin treatment is associated with a
reduction in cardiovascular disease and
death in old (75–84 years) and very
old (85 years and over) adults with and
without type 2 diabetes.
UsingdatafromtheCatalanprimarycare
system database (SIDIAP), they identified
46 864 people aged 75 years or more
with no history of cardiovascular disease
between 2006 and 2015. Participants
were grouped into those with and without
type 2 diabetes and as statin non-users
or new users (anyone starting statins for
the first time during the study enrolment
period). Primary care and hospital records
were then used to track cases of CVD
(including coronary heart disease, angina,
heart attack and stroke) and death from
any cause (all-cause mortality) over an
average of 5.6 years.
In participants without diabetes, statin
treatment was not associated with a
reduction in CVD or all-cause mortality in
both old and very old age groups, even
though the risk of CVD in both groups
was higher than the risk thresholds
proposed for statin use in guidelines.
In participants with diabetes, however,
statins were associated with significantly
reduced levels of CVD (24%) and all-cause
mortality (16%) in those aged 75–84 years.
But this protective effect declined after age
85 and disappeared by age 90.
This was an observational study, so no
firm conclusions can be drawn about cause
and effect, and the authors cannot not rule
out the possibility that some of their results
may be due to unmeasured (confounding)
factors.
But they point out that this was a
high-quality study with a large sample
size, reflecting real-life clinical conditions.
Therefore they concluded that their results
do not support the widespread use of
statins in old and very old populations, but
they do support treatment in those with
type 2 diabetes younger than 85 years.
In a linked editorial, Aidan Ryan at
University Hospital Southampton and
colleagues, say the biggest challenge for
clinicians is how to stratify risk among
those aged more than 75 years to
inform shared decision making. These
observational findings should be tested
further in randomised trials, they write. In
the meantime, they say ‘patient preference
remains the guiding principle while we
wait for better evidence.’
Source: Medical Brief 2018