Statins are effective in the elderly, but data are limited for those without established vascular disease

Reference

Cholesterol Treatment Trialists' Collaboration, Armitage J, Baigent C, et al. Efficacy and safety of statin therapy in older people: a meta-analysis of individual participant data from 28 randomised controlled trials. Lancet 2019;393(10170):407-415.

Synopsis

The members of the Cholesterol Treatment Trialists' Collaboration have pooled the patient level data from randomized trials of statins that evaluated low-density lipoprotein (LDL) concentrations and included at least 1000 patients who were followed up for at least 2 years. These data from 28 studies and more than 186,000 total patients included more than14,000 patients 75 years or older (~ 8% of the total pool). The researchers followed up these patients for a median of 5 years. They used an intention-to-treat analysis to evaluate the main outcomes of major coronary events (nonfatal myocardial infarction or coronary death), coronary revascularization, stroke, cancers, and all-cause mortality. Among patients older than 75 years, 2.6% of statin-treated patients experienced a major coronary event each year compared with 3% of control patients (number needed to treat = 250 per year). The authors report there was a barely significant 13% relative reduction in cardiovascular events for every mmol/L reduction in LDL concentration (relative risk 0.82; 95% CI 0.70 - 0.96). However, the rate of revascularization and stroke was not significantly decreased with statins. The authors also found no effect of statins on incident cancers or cancer mortality. Finally, although the data were limited, patients without vascular disease at the time of enrollment experienced no significant reduction in events.