Statins appear to benefit all ages, may be less helpful for primary prevention in the elderly
A meta-analysis by the Cholesterol Treatment Trialists' Collaboration looked at the effect of statins on major vascular events, cause-specific mortality, and cancer incidence.
Statins appear to benefit all age groups but may have less of an effect for primary prevention among patients older than age 75 years without preexisting vascular disease, according to a recent meta-analysis.
Researchers from the Cholesterol Treatment Trialists' Collaboration looked at randomized trials of statin therapy that had a recruitment goal of 1,000 participants or more and had a scheduled treatment duration of at least two years. Individual-patient data were analyzed from 22 trials that compared statins with control (n=134,537) and five trials that compared more intensive and less intensive statin therapy (n=12,705). In addition, detailed summary data were analyzed from one trial that compared statins with control (n=39,612).
Age groups in the meta-analysis were 55 years or younger, 56 to 60 years, 61 to 65 years, 66 to 70 years, 71 to 75 years, and older than 75 years. The primary outcome of the meta-analysis was the effect of statins on major vascular events (major coronary events, strokes, and coronary revascularization), cause-specific mortality, and cancer incidence. Results were published Feb. 2 by The Lancet.
Overall, 8% of the patients in the 28 included trials were older than 75 years at the time of randomization. Median duration of follow-up was 4.9 years. Statin therapy or a more intensive statin regimen was associated with a reduction in major vascular events overall (rate ratio, 0.79; 95% CI, 0.77 to 0.81), with a significant reduction seen in each age group. Major coronary events, risk for coronary revascularization procedures, and stroke were each reduced with statin therapy or more intensive statin therapy (rate ratios, 0.76 [95% CI, 0.73 to 0.79], 0.75 [95% CI, 0.73 to 0.78] and 0.84 [95% CI, 0.80 to 0.89], respectively).
A trend was seen toward smaller proportional risk reductions for major coronary events with increasing age (P=0.009 for trend), while reductions in risk for coronary revascularization procedures (P=0.6 for trend) and stroke (P=0.7 for trend) did not appear to differ significantly across age groups. The proportional reduction in major vascular events was similar in patients who had preexisting vascular disease regardless of age (P=0.2 for trend) but appeared to be smaller in older versus younger patients without preexisting vascular disease (P=0.05 for trend). Statin therapy did not appear to have an effect on nonvascular mortality rates, death from cancer, or cancer incidence in any age group.
The authors noted that the absolute risks of major vascular events and mortality in their meta-analysis are not generalizable to any population because of the differences among the included trials. However, the proportional effects of statins are likely to be widely generalizable, they said.
“Statin therapy produces significant reductions in major vascular events, irrespective of age,” the authors concluded. “There is less definitive direct evidence of benefit in the primary prevention setting among patients older than 75 years, but evidence supports the use of statin therapy in older people considered to have a sufficiently high risk of occlusive vascular events.”