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There’s been a longstanding debate about the effectiveness and necessity of lipid-lowering therapies, especially statins, in older adults. A recent Danish cohort study involving 65,190 individuals aged 50 and above has provided some illuminating insights into this topic. The rates of use of statin therapy has been shown to decline in people above age 75. This applies even to people who are known to have cardiovascular disease. The decline in statin usage is even more sharp in those who do not have cardiovascular disease.  

The Conventional Wisdom and the Emerging Data

Traditionally, the focus of lipid-lowering therapy, particularly aiming to reduce low-density lipoprotein cholesterol (LDL-C), has been on younger populations. But does this mean our approach should differ as we age? This study suggests perhaps not.

What the Study Reveals

The Danish research team embarked on an observational study using national healthcare and administrative registries to understand the impact of initiating lipid-lowering treatments in older adults. Their findings:

* Substantial Risk Reductions: For each 1mmol/L reduction in LDL-C, there was a 23% decreased risk of major vascular events, regardless of whether individuals were older or younger than 70.

* Uniform Benefits Across Ages: These benefits were consistent in both the older (≥70 years) and younger (<70 years) groups, indicating that age does not diminish the effectiveness of these therapies.

* Supportive Observational Data: Complementing this data are findings from Giral and colleagues, who observed lower rates of cardiovascular events in those who continued statin treatment past the age of 75, compared to those who stopped. It included people who had taken statins regularly but hadn’t had heart problems before. The study found that stopping statins increased the risk of hospital admission for heart issues by 33%.

Broader Implications and Future Directions

This study aligns with data from the Cholesterol Treatment Trialists Collaboration and other primary prevention trials. The Cholesterol Treatment Trialists Collaboration has been running since 1994. It conducts meta-analyses of cholesterol intervention trials. The Collaborations aims to assess whether interventions on lipid-lowering work in different types of people. A meta-analysis allows a more reliable assessment of the effect of an intervention than a single trial alone. Previously, they have demonstrated that statin therapy does not increase the risk of cancer or of other non-cardiac causes of death. The key takeaway is that lowering LDL-C levels is crucial for reducing cardiovascular risk, regardless of age.

Two prospective randomised trials are also on the horizon, promising to provide more clarity on this topic for older adults. These include the STAREE study, focusing on patients over 70, and the SITE/SAGA study, examining statin cessation in individuals 75 years or older. While we now have some clarity for over 50s, there is still debate as to whether statins are useful and cost-effective for over 75s. These two studies should provide some clarity.

My Perspective

The message here is clear: preventing cardiovascular events is a universal goal, transcending age barriers. These new findings reinforce the importance of managing cholesterol levels even in older adults. It’s not about the number of candles on a birthday cake; it’s about the numbers that count for heart health. 

For our younger patients, it’s important not to delay statin treatment. A study in the journal  Circulation analysed data to uncover when younger adults should start statins to prevent heart disease over 30 years. It found that starting cholesterol-lowering treatments in your 40s, especially if your LDL is high, could significantly reduce the risk of heart disease later on. This study suggests it might be more important to decide when to start treatment rather than if you should start at all.

Make sure you have your discussed your risk of cardiovascular disease and discussed a plan to lower your risk with your GP.

Please help another person improve their heart health by sharing this blog.

Dr. J. Hugh Coyne

Private GP

Coyne Medical