Heart failure

Statin meta-analysis provides strong evidence for benefits in over 75s

Statin therapy produces significant reductions in major vascular events irrespective of age, including in people over 75 years, according to an Australian meta-analysis.

Published in The Lancet, the systematic review by researchers at the NHMRC Clinical Trials Centre (CTC) compared the effects of statin therapy in nearly 187,000 people who had taken part in 28 large randomised controlled 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.

During five years of follow up, statin treatment was associated with a 24% proportional reduction in major coronary events per 1·0 mmol/L reduction in LDL cholesterol, with similar benefits across all ages – even those over 75 years.

Smaller relative reductions in risk were seen with increasing age, but “as the absolute risk of these events was higher in older people, the absolute benefits were similar to, if not greater than, those at younger ages.”

Cardiovascular risk reductions were observed in people with or without known vascular disease at the start of the trials, though there was a weak trend towards smaller relative risk reductions with increasing age in the primary prevention setting.

Summarising the findings, Professor Garry Jennings Chief Medical Advisor of the Heart Foundation said the analysis “provided strong support for the use of statins in people aged over 75 who have a history of heart or vascular disease, probable benefit for people aged over 75 without a history of heart or vascular disease and no support for their routine use in older people with heart failure or on dialysis treatment. “

However, given the diversity of studies included in the meta-analysis, it is not enough to provide a definitive answer to the question of who benefits from statins at an older age,” he added.

“Nevertheless, this is important new information and provides support for current common practice in prescribing statins to older people, especially those with a history of heart or vascular disease.

It also adds to the huge amount of evidence that statins do not cause cancer in older people, he said.
Co-investigator, Dr Jordan Fulcher from the University of Sydney, said the analysis provided 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.”

Dr Fulcher also noted that the Australian-led STAREE study of 18,000 people aged 70 years or more is specifically exploring whether statin treatment can prolong survival free of disability in a healthy elderly population.

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