75 or Older? Statins Can Still Benefit Your Heart
Older adults with healthy hearts probably would benefit from taking a cholesterol-lowering statin, a new study contends.
People 75 and older who were free of heart disease and prescribed a statin wound up with a 25% lower risk of death from any cause and a 20% lower risk of heart-related death, researchers reported July 7 in the Journal of the American Medical Association.
"Based on these data, age is not a reason to not prescribe statins," said lead researcher Dr. Ariela Orkaby, a physician-scientist at the VA Boston Healthcare System and associate epidemiologist with Brigham and Women's Hospital in Boston.
Statins are drugs used to prevent buildup of plaques that can narrow or block arteries, leading to heart attack and stroke.
Until recently, guidelines recommended halting statin therapy at age 75, said Dr. Mary Ann McLaughlin, medical director of the Cardiac Health Program at Mount Sinai Hospital in New York City.
"In 2018, the guidelines changed to say statins are a reasonable choice for those older than 75 without a life-limiting disease" like cancer or organ failure, she said.
This new study provides evidence that changing the guidelines to allow statin therapy to continue was the right move, said McLaughlin, who wasn't part of the research.
"This age group is one of the fastest-growing groups," she said. "The over-75 cohort is living even longer, and the first evidence of atherosclerotic disease or cardiovascular disease can be sudden death. There are many patients who are living very active and full lives into their late 80s and 90s these days."
For this study, Orkaby's team analyzed data from more than 300,000 veterans 75 or older who used VA health care services between 2002 and 2012. None had experienced a heart attack, stroke or other heart problem.
Of those vets, more than 57,000 started taking statins during that period. Researchers compared those who used statins against those who did not, and found that their risk of heart-related death was significantly lower.
The benefits remained for veterans at advanced ages, including those 90 or older, and also were strong among vets with dementia, results showed.
Patients on statins also had a lower risk of heart attacks and strokes, researchers said.
Because the study relied on VA data, the patients involved were overwhelmingly male (97%) and white (91%), McLaughlin noted.
But randomized clinical trials now underway will provide additional evidence about statin use in a broader mix of older people, Orkaby and McLaughlin said.
There's been an age bias in statin clinical trials, because older folks tend to have more medical problems and including them can confuse the results, Orkaby said.
"Older adults usually have more than one thing going on," she said. "It's much easier to study people in their 50s who may just have high blood pressure or just have diabetes. When you're running a big trial, you may not want to include people who are going to get hospitalized for some other issue -- for example, because they fell."
As a result, "almost all the data that exists right now for statins is in younger people, even though it's really older adults who have the highest risk of having a heart attack or a stroke," Orkaby said.
These new results indicate it's time to stop discriminating based on age alone and saying there is no data to support statin use in older folks, she said.
"We have some reasonably good data to suggest that statins could save lives," Orkaby said. "If you got to 75 and you weren't yet put on a statin, you may actually be a healthier older adult who's likely to live another 10 or 15 years. Those people may be the ones who would benefit the most from that, long-term."
The U.S. National Institutes of Health has more about statins.
SOURCES: Ariela Orkaby, M.D., M.P.H., physician scientist, VA Boston Healthcare System and associate epidemiologist, Brigham and Women's Hospital, Boston; Mary Ann McLaughlin, M.D., medical director, Cardiac Health Program, Mount Sinai Hospital, New York City; Journal of the American Medical Association, July 7, 2020