Are statins really a ‘waste of time’ for over-75s?

Statins

A new study has reported that statins don’t reduce risk of heart attacks and stroke for over 75s without existing heart or circulatory diseases. We go behind the headlines to get to the truth and ask whether statins really are worth taking.

6th September 2018

New research has suggested that over 75s taking statins to reduce their risk of heart attacks and stroke don’t receive any benefit from the pills – unless they have diabetes.

Firstly, it’s important to note that this study involved people without any existing heart or circulatory disease, meaning its findings are not relevant to those who are taking statins to reduce their risk of having another heart attack or stroke.

Researchers found that for over-75s who didn’t have heart or circulatory disease or diabetes, taking statins wasn’t linked to a significantly lower risk of developing coronary heart disease or stroke. However they did find a benefit in people with diabetes, who have a higher risk of having a heart attack or stroke than the general population. Statins appeared to reduce coronary heart disease and stroke in over-75s with diabetes, but only up until the age of 84.

Current statin prescribing guidelines are based on a calculation of risk, which includes age. 

The research

The study was carried out by researchers at the University of Girona in Spain and was published in the British Medical Journal.

A limitation of the study is that it was ‘observational’, meaning that the researchers collected retrospective data about patients from their healthcare records. This means that other factors could have influenced the results. Carrying out a well-designed clinical trial would be the gold-standard method for answering important medical questions like this. 

The researchers collected data from 46,864 people without heart or circulatory disease over the age of 75, including whether they had taken a statin, and subsequently whether they had developed coronary heart disease, stroke, or had died.

They found that people over 75 who had taken a statin weren’t significantly less likely to have a heart attack or stroke than those who hadn’t taken a statin.

But for people with diabetes, statins were linked to a 24 per cent lower risk of developing coronary heart disease or stroke, and of dying from any cause by 16 per cent. This protective effect was seen in those aged 75-84 and became much weaker over the age of 85.

The researchers concluded: ‘These results do not support the widespread use of statins in old and very old populations, but they do support treatment in those with diabetes who are younger than 85 years.’

The BHF view

Professor Jeremy Pearson, Associate Medical Director at the British Heart Foundation, said:Old age itself – particularly reaching the age of 80 and above - puts people at increased risk of a heart attack or stroke. This risk can be heightened by factors such as high cholesterol, diabetes and high blood pressure, even in those who are otherwise seemingly healthy.”

“Previous clinical trials – which are a better measure than observational studies like this - have also suggested that statins can contribute to a reduction in risk of a heart attack or stroke in elderly people with no history of heart disease. However, further trials are needed to better understand how effective they are in this age group. Regardless of age, those who have suffered a heart attack or stroke will benefit from taking a statin. 

Regardless of age, those who have suffered a heart attack or stroke will benefit from taking a statin.

“In line with current guidance, the most important thing is that GPs have a discussion with their elderly patients to help them understand their personal risk of a heart attack or stroke, so they can make an informed decision about taking statins.”

How the research was reported

Media coverage of the study focussed on the results finding no benefit for the ‘healthy’ over-75s taking statins to reduce their risk of heart disease and stroke.

The Mirror reported “Statins 'have no benefit' for thousands of healthy older people taking them”, while the Daily Mail concluded “Millions given statins 'just in case' are wasting their time and don't receive any benefit, study finds”.

While the results do challenge current guidelines, most news coverage also highlighted that an observational study alone is not strong enough to change current practice, and that carefully controlled clinical trials in the over-75s are needed to give a conclusive answer.

Further studies will gather more evidence on this issue. So until then, if you’re not sure whether to take a statin, it’s important to discuss this issue with your doctor to help you reach an informed decision.

 

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