Statins may reduce MI, stroke risk in elderly patients without established CVD

Statins may reduce risk of myocardial infarction (MI) and stroke in elderly patients without established cardiovascular disease (CVD), but they don't appear to affect short-term survival, according to a new meta-analysis.

Researchers analyzed eight trials to determine whether statins would benefit those without a history of CVD. Included trials randomly assigned patients to statins or placebo, reported outcomes in those who were at least 65 years of age at randomization and who did not have established CVD, and reported at least one of the following: all-cause death, cardiovascular death, MI, stroke or new onset of cancer. Relative risks were calculated for treatment effect and for each outcome by intention to treat, and overall estimates of effect were calculated with fixed-effects or random-effects models. The study results were published early online by the Journal of the American College of Cardiology.

The eight trials involved 24,674 elderly patients, 47% of whom were women, with a mean age of 73 years and a mean follow-up of 3.5 years. A total of 12,292 were assigned to statins and 12,382 were assigned to placebo. Overall, 2.7% of patients taking statins and 3.9% of those taking placebo had an MI during the follow-up period (relative risk, 0.606; P=0.003), while 2.1% and 2.8%, respectively, had a stroke (relative risk, 0.762; P=0.006). However, statins did not appear to reduce the risk for all-cause death (relative risk, 0.941; P=0.210) or cardiovascular death (relative risk, 0.907; P=0.493) compared with placebo, and new cancer onset did not appear to differ by treatment group (relative risk, 0.989; P=0.890).

The authors noted that their study was based on aggregate data, that only two of the included studies were designed for elderly patients, and that the follow-up was relatively short, among other limitations. However, they concluded that statins can reduce short-term incidence of MI and stroke in elderly patients without established CVD.

The current study, said an editorialist, “clearly answers the question of whether statins reduce events in primary prevention of individuals aged 65 or older.” He pointed out that all of the patients included in the study had risk factors besides their age, including hypertension, diabetes, high low-density lipoprotein cholesterol level, low high-density lipoprotein cholesterol level, or a high level of C-reactive protein.

“Older people differ more among themselves than younger ones do, and the decision to treat or not treat an older individual with a statin often requires clinical discernment,” the editorialist wrote. “The clear results of this meta-analysis will hopefully lead to more older individuals receiving treatment that will reduce their [cardiovascular] risk.”