Irrespective of age, statins reduced risks of major vascular events by about a fifth per 1 mmol/L reduction in LDL cholesterol. For major coronary events the overall reduction ranged from about 30% in those aged <55 years to around 20% in those aged >75. The relative risk reductions for stroke and for coronary revascularisation (coronary stenting or bypass surgery) were similar in all age groups.
Of the 186,854 participants in the 28 trials that were reviewed, with a mean age of 63 years, 14,483 were older than 75 years.
The analysis focused on the effects of statin therapy on major vascular events, mortality and cancer, and the authors limited their meta-analysis to large trials, known to generate the most reliable evidence. Previous studies have shown that the benefits of statins outweigh the risk of other adverse events (such as myopathy), and ongoing work in this area is being conducted by the Cholesterol Treatment Trialists’ Collaboration.
Responding, RCGP Vice Chair Professor Martin Marshall, said: ‘It’s encouraging to see further research showing that statins are safe and effective drugs that can reduce risk of cardiovascular conditions when prescribed appropriately, as there remains a lot of controversy around their use.
‘It’s particularly reassuring to see evidence of benefit in patients over the age of 75 – the age group most likely to need cholesterol medication, and who are at risk of heart attacks and strokes.’
Cholesterol Treatment Trialists’ Collaboration. Lancet 2019;393(10170):407-415
