Statins Can Modestly Reduce Cardiovascular Events in Later Old Age
Therapies that lower serum LDL cholesterol can modestly reduce the risk of cardiovascular events in people with raised serum LDL cholesterol, meaning heart attack and stroke resulting from rupture of an atherosclerotic plaque. Greater circulating LDL cholesterol maintained over years and decades is one of the contributing factors leading to the growth of these fatty plaques in blood vessel walls. Statins and other LDL-lowering approaches slow the growth of plaque and over the course of years will change the plaque composition from soft and vulnerable to more calcified, fibrotic, and stable. This approach cannot regress existing plaque meaningfully in more than a fortunate few patients, however. The average plaque reduction reported in meta-analyses is near zero. The cardiovascular event risk reduction is generally thought to top out at 20% or so, while many studies show little to no risk reduction. Better therapies are needed.
Researchers have provided the first comprehensive evidence of the benefits of statin use in elderly patients, addressing longstanding uncertainties. The robust evidence demonstrated that continuous statin therapy resulted in a substantial relative risk reduction in cardiovascular diseases (CVDs) of 21% for those aged 75-84 and 35% for those aged 85 or above, without any heightened safety concerns.
CVD is a leading healthcare burden globally, particularly in ageing populations. Effective management of high cholesterol is a crucial intervention in the prevention of CVDs. According to the latest 'Population Health Survey' in Hong Kong, 65.6% of individuals aged 65-84 have high cholesterol. While statins have been used for decades to improve lipid profiles and reduce the risk of CVDs, there is little consensus on the use of statins for primary prevention in patients aged 75 or above in the existing international clinical guidelines.
The research team analysed the public electronic medical records from January 2008 to December 2018 of over 80,000 older individuals in Hong Kong who had suboptimal lipid levels and high-risk conditions, such as diabetes or other risk factors for CVDs. The findings indicate that the continual use of statins was linked to a 21% reduction in relative risk and an absolute risk reduction of 5% over five years in CVDs among people aged 75-84. The relative risk reduction was an even more substantial 35%, and the absolute risk reduction after five years was 12.5% in those aged 85 or above. The study also found no increased risk of major adverse events, including liver dysfunction or myopathies, identified with statin use in this population.