August 29th, 2013

Statins Reduce Cardiovascular Events in Elders Without Established CVD

Statins are associated with lower risks for myocardial infarction and stroke among elders without established cardiovascular disease, according to a meta-analysis in the Journal of the American College of Cardiology.

The analysis included eight randomized, placebo-controlled trials comprising nearly 25,000 patients aged 65 and older without CVD at baseline. During 3.5 years’ follow-up, statin use was associated with a 39% reduction in the risk for MI and a 24% reduction in the risk for stroke. The researchers estimate that 24 patients would need to be treated for 1 year to prevent one MI, and 42 to prevent one stroke.

There was a trend toward a reduction in mortality, but this did not reach statistical significance.

The researchers say their study “provides first time evidence” that statins’ cardiovascular benefits extend to people aged 65 and older without CVD.

2 Responses to “Statins Reduce Cardiovascular Events in Elders Without Established CVD”

  1. Antonio H. Reis, Ph.D says:

    Why use statins in primary prevention?
    The Cochrane Collaboration: “Statins do not have a proven net health benefit in primary prevention populations and thus when used in that setting do not represent good use of scarce health care resources.” (Do statins have a role in primary prevention? An update. “Therapeutics Letter, March-April 2010”. Therapeutics Initiative University of British Columbia)
    A recent study (Scandinavian J. of Primary Health Care. 2013;31:172-80) found that high cholesterol and LDL-cholesterol levels in subjects over 50 years was associated with lowered all-cause mortality. Compared to those with cholesterol <190mg/dL, those aged 60-70 years with a cholesterol level from 190-230mg/dL had a 32% lowered mortality rate. Those with a cholesterol level from 230-308mg/dL had a 33% reduced mortality rate.

  2. Uffe Ravnskov, MD, PhD says:

    Why haven´t the authors given the absolute risk? To present the results as relative risk is grossly misleading. For instance, if there were ten cases of CHD in the control groups and six cases in the treatment groups, this would be a 39 % relative risk reduction, but only a 0.03 % absolute risk reduction
    Furthermore, as Antonio Reis points out, old people with high cholesterol live the longest. This was the finding, not only in the Scandinavian study, but also in 22 other studies cited below.

    1. Kozarevic D et al. Am J Epidemiol. 1981;114:21-8.
    2. Rudman D et al. J Am Geriatr Soc. 1987;35:496-502.
    3. Forette B et al. Lancet. 1989;1:868-70.
    4. Staessen J et al. J Hypertens. 1990;8:755-61.
    5. Harris T et al. J Clin Epidemiol. 1992;45:595-601.
    6. Casiglia E et al. Eur J Epidemiol. 1993 Nov;9(6):577-86.
    7. Krumholz HM et al. JAMA 1994;272:1335-40.
    8. Weverling-Rijnsburger AW et al. Arch Intern Med. 2003;163:1549-54.
    9. Jonsson A et al. Lancet 1997;350:1778-9
    10. Räihä I et al. Arterioscler Thromb Vasc Biol. 1997;17:1224-32.
    11. Behar S et al. Eur Heart J. 1997;18:52-9.
    12. Fried LP et al. JAMA 1998;279:585-92.
    13. Chyou PH et al.. Age Ageing. 2000;29:69-74.
    14. Schatz IJ et al. Lancet. 2001 Aug 4;358(9279):351-5.
    15. Weverling-Rijnsburger AW et al. Arch Intern Med. 2003;163:1549-54.
    16. Onder G et al. Am J Med. 2003;115:265-71.
    17. Casiglia E et al. J Intern Med. 2003;254:353-62.
    18. Psaty BM et al. J Am Geriatr Soc. 2004;52:1639-47.
    19. Ulmer H et al. J Womens Health 2004;13:41-53.
    20. Schupf N et al. J Am Geriatr Soc. 2005;53:219-26.
    21. Akerblom JL et al. Age Ageing. 2008;37:207-13.
    22. Newson RS et al. J Am Geriatr Soc. 2011;59:1779-85.