A recent article in the Lanceton the efficacy and safety of statin therapy in older adults. It was a meta-analysis of individual participant data from 28 randomized trials. The article brings into question the practice of using statins for primary prevention in older adults, those aged 70-75 years.
The authors remarkably analyzed individual participant data from 22 trials of over 130,000 individuals. They also included detailed summary data from one trial of over 12,000 individuals, as well as trials of statin therapy, high-dose vs low-dose, which was another 40,000 individuals. So, almost 200,000 individuals were enrolled in randomized, blinded control studies.
Approximately 8% of those individuals, over 14,000 people, were older than 75 years of age at the time of randomization. The median duration of follow-up was about 5 years.
Overall, statin therapy worked very well at reducing future major vascular events. There was also a 21% reduction in major vascular events for every 40 mg/dL decrease in LDL cholesterol.
However, the benefit was seen in people who had a history of vascular events. But, when looking at people older than 70-75 years of age, who had no history of previous vascular events, the authors noted the use of statin therapy showed no evidence of benefit on cardiac endpoints. In other words, statin therapy for primary prevention in those >70-75 years of age did not appear to be beneficial in this meta-analysis.
Take-away message
Well, greater than 30% of individuals over 70 years of age are currently on statins. This analysis suggests that we should really use a shared decision-making model when discussing the use of statin therapy in individuals >70-75 years of age who don’t have a history of previous vascular events.
For secondary prevention, statins work. Patients who have had an MI or a stroke, regardless of age, should be on a statin. But, for healthy patients without a history of vascular events, the pooled cohort equation and traditional thinking of “if someone has a >7.5% 10-year risk of cardiac disease, they should be on a statin,” does not necessarily apply to this older age group.
Is this a practice changer?
This meta-analysis clearly shows that statin therapy as primary prevention in individuals >70-75 years of age may not be beneficial, and we should use a shared decision-making model when considering the addition of statin.
References:
Cholesterol Treatment Trialists’ Collaboration. Lancet. 2019;393(10170):407-415. doi:10.1016/S0140-6736(18)31942-1.
