Statin therapy found safe and effective in over 75s
Statin therapy is safe and effective in older people over 75 years and reduces major vascular events such as heart attacks and strokes, according to researchers from the Australian–UK Cholesterol Treatment Trialists’ (CTT) Collaboration.
Statins help lower the level of low-density lipoprotein (LDL) cholesterol in the blood, which if left untreated can lead to hardening and narrowing of the arteries and cardiovascular disease. They are prescribed to millions of people globally, including the elderly — but most individual statin trials previously considered ‘elderly’ people those aged over 65. With life expectancies now much greater, questions around the effectiveness of treatments have focused on even older age groups.
“Statin therapy has been shown to prevent cardiovascular disease in a wide range of people, but there has been uncertainty about its efficacy and safety among older people over 75 years,” said lead investigator, Professor Anthony Keech, Deputy Director of the NHMRC Clinical Trials Centre at the University of Sydney.
With this in mind, Prof Keech and his colleagues compared the effects of statin therapy in nearly 187,000 people who had taken part in 28 large clinical trials. Participants were divided into six different age groups ranging from under 55 years to over 75 years to assess the effects of statins on major vascular events (heart attacks, strokes, coronary revascularisations), cancer incidence and deaths. The results were published in The Lancet.
The researchers found that statin treatment reduced the risk of a major vascular event by about a quarter for each millimole per litre reduction in LDL cholesterol, with similar benefits across all ages — even those over 75 years. They also found that statin therapy did not increase the risk of deaths from non-cardiovascular disease, or the risk of cancer, at any age.
Cardiovascular risk reductions were observed irrespective of age, in people with or without known vascular disease at the start of the trials. The evidence was less definitive among people aged over 75 without pre-existing vascular disease (those who were prescribed statin therapy for the ‘primary prevention’ of heart attacks and strokes). New randomised trials are now studying the effects of statins in more depth in apparently healthy older people.
“Our analysis found that statin therapy appears to be just as effective in people aged over 75 years as it is in younger people,” said co-investigator Dr Jordan Fulcher from the University of Sydney. “We now have definitive evidence that statins benefit older people who have suffered a heart attack or stroke.
“This study will provide reassurance and guidance for doctors and patients alike that people are not automatically ‘too old’ for treatments like statins to be effective.”
Co-investigator Professor Colin Baigent, Director of the Medical Research Council Population Health Research Unit at the University of Oxford, added: “The risk of heart attacks and strokes increases markedly with age, and yet statins are not utilised as widely in older people as they should be.
“Since the risk of heart attack and stroke increases with age, the potential benefits are likely to be even greater for older people.
“Therefore, there is a need to ensure that patients at risk of cardiovascular disease due to their age are offered statin therapy where there is good reason to believe that it will be beneficial. Anyone with concerns about whether statin therapy is suitable for them should discuss this with their GP.”
Dr Fulcher acknowledged that fewer healthy older people were represented in the clinical trials, so more information on this group of people would help confirm the same benefits that were found in the overall trials population. Luckily, a new randomised trial, called STAREE, has been designed to do exactly that, exploring whether statin treatment can prolong survival free of disability in a healthy elderly population.
Set to include 18,000 people aged 70 years or more, the STAREE trial is being run by Monash University investigators and is expected to fill in any gaps that remain after this initial meta-analysis. For more information, visit http://www.staree.org.au/.
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