Should Everyone Over 65 Take a Statin?
WEDNESDAY Aug. 28, 2013 -- Men and women over 65 who are at risk for cardiovascular disease but don't have any known heart problems might benefit from cholesterol-lowering drugs, a new study suggests.
The researchers said statins such as Crestor and Lipitor can reduce the risk of heart attack and stroke, although they don't seem to prevent death from cardiovascular disease or other causes over the short term.
"This is the first time the benefit of these drugs has been demonstrated in this population of patients," said senior study author Dr. Pasquale Perrone-Filardi, from the department of advanced biomedical sciences at Federico II University in Naples, Italy.
These findings fill a gap in current guidelines, Perrone-Filardi said. To date, there has been no firm evidence that statins benefit patients who haven't had a heart attack or stroke, he said. There also has been no evidence showing the benefits of using the drugs for what is known as primary prevention.
"[This new data] would not [make me] recommend statins for all older patients, but maybe for patients with hypertension or atherosclerosis," Perrone-Filardi said.
For the new study, Perrone-Filardi's team reviewed data from eight previously published trails that included nearly 25,000 participants. These patients were at risk for cardiovascular disease but hadn't had a previous heart attack or stroke.
This type of study, called a meta-analysis, attempts to find common patterns in data from several unrelated trials.
In these trials, which compared statins and placebos in patients followed for an average of three and a half years, statins reduced the risk of heart attack by about 29 percent and stroke by nearly 24 percent, the researchers found.
In terms of preventing death from any cause, however, statins did not have an effect, the researchers said.
Despite the new findings, Perrone-Filardi doesn't think everyone over 65 should be taking statins. The patients who benefit are those with a high risk for cardiovascular disease, he said.
"The problem is that age is one of the main risk factors for cardiovascular disease, so it's difficult to detect among a population of old people who are the patients at very high cardiovascular risk," he said.
The study, which did not receive any drug-company or other outside funding, was published Aug. 28 in the Journal of the American College of Cardiology.
In the United States, guidelines already recommend statins for primary prevention of heart attack and stroke, an expert said.
"Statins have been proven to substantially reduce fatal and nonfatal cardiovascular events in individuals without known cardiovascular disease, even among men and women with cholesterol levels considered in the normal range," said Dr. Gregg Fonarow, a spokesman for the American Heart Association.
Guidelines in the United States recommend statin therapy for primary prevention in men and women regardless of age. The guidelines from the European Society of Cardiology, however, do not provide recommendations for statin use in older people, Fonarow said.
The benefits of statins outweigh their risks for primary prevention in the clinical trials conducted so far, said Fonarow, a professor of cardiology at the University of California, Los Angeles.
"As cardiovascular disease remains the leading cause of death, disability and health care expenditures among men and women age 65 years or older - and most men and women in this age range are at intermediate or high risk for cardiovascular events - statins, together with a healthy diet and regular exercise, represent one of the most effective ... strategies for individual and population-level cardiovascular health," Fonarow said.
Cost is a consideration for any drug taken regularly. An April 2012 issue of Consumer Reports noted that statins vary widely in cost - anywhere from $12 to more than $500 each month. The article, however, listed generic statins that can cost just a few dollars a month when supplied through programs run by major chain stores.
For more about statins, visit the U.S. National Library of Medicine.
Posted: August 2013