Statin experts push for increased prescription to over-75s

Alex Williams
Fri, 01 Feb 2019
Statin experts push for increased prescription to over-75s
A report from a group of statin researchers has concluded that statin therapy significantly reduces risk of major vascular events, irrespective of age.

Statins act by reducing the amount of cholesterol produced by the liver, which is thought to lower risk of cardiovascular disease.

There has previously been a lack of evidence about the benefits of statins for over-75s, but a meta-analysis of the existing research suggests that this age group can also benefit. The age groups of the participants ranged from under-55s to over-75s.

The technique used to assess the evidence in this report, which is a meta-analysis of randomised controlled trials, is considered the gold-standard of scientific study. A total of 28 randomised controlled trials, which involved nearly 190,000 patients, were included in the analysis.

Lead investigator Professor Anthony Keech, of the University of Sydney, summarised the study: "Statin therapy has been shown to prevent cardiovascular disease in a wide range of people, but there has been uncertainty about its efficacy and safety among older people. Our study summarised all the available evidence from major trials to help clarify this issue.

"We found that there were significant reductions in major vascular events in each of the six age groups considered, including patients aged over 75 at the start of treatment."

The conclusion of the report itself does acknowledge, however, that there is less direct evidence of benefit among patients over 75 years of age who do not already have vascular disease. It is hoped that this limitation will be addressed by future trials.

The analysis reported approximately a quarter reduction in relative risk of major vascular events such as heart attack, stroke and coronary revascularisation, per mmol/L reduction in LDL cholesterol. However, framing the data in such a way is not necessarily directly applicable to the patient. The so-called ‘absolute risk’ reduction value will be much lower once converted.

One major issue with statins is that they are known to carry risk of side-effects such as muscle pain, digestive issues and increased risk of developing type 2 diabetes.

As explained by Dr Aseem Malhotra, it has been reported that around 20% of patients taking statins suffer unacceptable side-effects. Dr Malhotra has also warned that scientific journal articles can sometimes act as marketing vehicles for the pharmaceutical industry, and has stressed that open discussion with the best available evidence should be had when considering statin prescription with patients.

It is also worth noting that many of the study’s authors have declared conflicts of interest, receiving funding for other projects from pharmaceutical companies such as Pfizer, Merck and AstraZeneca, which all produce statins.

Many believe that an open discussion with one’s GP is important when considering statin therapy. Professor Martin Marshall, vice-chairman of the Royal College of General Practitioners said: "GPs are highly trained to prescribe and will only recommend the drugs if they think they will genuinely help the person sitting in front of them, based on their individual circumstances - and after a frank conversation about the potential risks and benefits".

The analysis was published in The Lancet.
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