The headlines this week have been emphatic: “Study: Proof Statins Help Older People.” Then there was this one: “Cholesterol Lowering Drugs Giving Older Adults Better Heart Health.” We were intrigued by the headline: “All over 75s Should Be Offered Statins but ‘Ageism’ is Failing Patients.” One might conclude that any doctor who doesn’t prescribe statins for older people is ageist. The gist of most of these headlines is that health professionals must be prescribing statins for older people regardless of their risk factors. The statin enthusiasm stems from a meta-analysis published in The Lancet (Feb. 2, 2019) Does the evidence support the hype?
Do Journalists Actually Read the Research They Report On?
We have long worried that many journalists barely read the abstract or the summary of the medical research they write about. We suspect that they do not dig into the data in any meaningful way.
Here is what the health editor wrote in The Guardian (Jan. 31, 2019) under the headline
“Thousands of deaths and the wrecking of many lives by disability could be averted if doctors routinely offered a daily statin pill to older people, scientists say.”
This makes it seem that if doctors don’t prescribe statins for older people, many are destined to die prematurely or experience a life with disability. Let’s see if the data support that conclusion.
Do Statins for Older People Help Prevent Heart Attacks?
The Cholesterol Treatment Trialists’ Collaboration has done a meta-analysis of randomized controlled trials comparing statins to placebo. About 8% of the volunteers in the 28 trials analyzed were over 75 at the beginning of their studies. They were followed up for approximately five years.
You can tell that the clinical trials, mostly sponsored by drug companies, did not actively recruit older people. Only 8% of the subjects qualified as elderly.
Statins for Older People Did Help…If the Risk Was High.
The older people in the study who had clearly diagnosed heart disease did benefit from statins. Among such volunteers over 75 years of age, 6% taking statins had a major vascular event compared to 7.3% on placebo. That’s something, but hardly a barn burner.
In actual numbers, there were 528 “events” in the over-75 statin-taking group with vascular disease. That’s out of 8,034 people. Among the 6,449 older people with vascular disease on placebo there were 606 events. That sounds really impressive if you call it a 26% relative risk reduction. The absolute risk reduction is 1.3% in people at high risk from existing heart disease.
Statins for Older People at Low Risk?
In the group of older people without heart disease, however, the absolute difference between statin and control groups was only 0.1%. That was not statistically significant.
Put another way, older people without diagnosed heart disease got little, if any, benefit from taking drugs like atorvastatin, pravastatin, rosuvastatin or simvastatin. The headlines did not make a distinction between older people with heart disease and those who were not at high risk. Many of the news stories made it seem as if doctors should prescribe statins for older people regardless of risk.
The Heart Risk Calculator:
Many primary care physicians rely upon the American Heart Association (AHA) and the American College of Cardiology (ACC) to provide guidance when it comes to prescribing statins for older people. The Heart Risk Calculator from the AHA and the ACC advises health professionals and patients to consider adding a statin based primarily upon age once a man is over 64 and a woman is over 67.
That’s even if cholesterol levels and blood pressure numbers are perfectly normal. An older person could be running 10 miles a day and eating mostly vegetarian fare and the AHA would still recommend a statin. If our analysis of the data in the new study (Lancet, Feb. 2, 2019) is correct, there is little, if any, benefit in prescribing statins for this healthy group of older individuals.
Other research has not been as enthusiastic about statins for older people. Here is a study published in a competing journal (The BMJ, Sept. 5, 2018). Should you wish to read our overview of this research, here is a link:
Are You Confused Yet?
It would be amazing if you weren’t totally confused. The research published in The Lancet was widely interpreted as a green light to prescribe statins for older people…all older people! If you read the newspaper headlines, you might believe that healthy people who didn’t take statins were risking disability or early death. And yet we have just offered research in reputable journals that contradicts that conclusion.
We apologize for muddying the waters. We always encourage you to ask your doctor about absolute risk reduction. How many people out of 100 will benefit from any given treatment? Another way to ask the question is this: doctor, what is the number needed to treat (NNT)?
In other words, how many people would have to take this medicine for one to get a meaningful benefit? If that number is more than 80 or 100, it might not be worth the risk. If only five or six people need to take a medicine for one to get a good outcome, that is a slam dunk winner!
And always ask about side effects. Here is a link to the most likely complications from statins:
Listen to a free statin standoff interview with both a statin enthusiast and a statin skeptic at this link. Here is a cardiologist who questions the cholesterol hypothesis. You can listen to Dr. Dubroff’s perspective at this link.
Share your own statin story in the comment section below.