Statins study questions their widespread use in the healthy elderly

A new observational study has questioned the benefits of prescribing statins to the healthy elderly.

The widespread use of statins in healthy pensioners aged over 75 to prevent heart disease has been questioned by new research published in the British Medical Journal.

The results of the observational study did not support the use of statins in old and very old populations, but did support their use for people with type 2 diabetes aged between 75 and 84.

Cardiovascular disease (CVD) is the leading cause of death worldwide, particularly for those aged 75 and over. Reflecting that, statin prescriptions to elderly patients have increased in recent decades, with trial evidence backing their use  for people aged 75 years or older with existing heart disease.

However, statins were not associated with a reduction in cardiovascular disease – conditions affecting the heart and blood vessels – or death in healthy people aged over 75, according to the research led by the University Institute for Primary Care Research Jordi Gol (IDIAPJGol) and Girona Biomedical Research Institute (IDIBGI) in Spain. But the researchers did note health benefits in selected people, such as those aged 75-84 years with type 2 diabetes.

Aged 75-84 years with type 2 diabetes

Commenting on the results, Aidan Ryan at University Hospital Southampton and colleagues, said the biggest challenge for clinicians was how to stratify risk among those aged more than 75 to guide decision-making.

The observational findings should be tested further in randomised trials, said Ryan and colleagues.  “Patient preference remains the guiding principle while we wait for better evidence,” they added.

The researchers drew their conclusions after studying data from the Catalan primary care system database (SIDIAP) to identify 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. Primary care and hospital records were used to track cases of CVD – including coronary heart disease, angina, heart attack and stroke – and death from any cause over an average of 5.6 years.

Thresholds proposed for statin use

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. That was despite the risk of CVD in both groups being higher than the risk thresholds proposed for statin use in guidelines.

But for participants with diabetes, statins were associated with significantly reduced levels of CVD (24%) and all-cause mortality (16%) in those aged 75-84 years. This protective effect declined after age 85 and disappeared by age 90.

Since the study was observational, no firm conclusions can be drawn about cause and effect, and the authors cannot rule out the possibility that some of their results may be due to unmeasured  factors. However, this was a high-quality study with a large sample size, reflecting real life clinical conditions, according to the researchers.