Clinical trial finds statins reduce heart attack and stroke risk in people over 70

Taking a common cholesterol-lowering medication can reduce the risk of a heart attack or stroke for people aged over 70, with a low risk of serious side effects, a world-first clinical trial led by Australian researchers has found.

Statins are already commonly prescribed to people under the age of 75 who meet certain risk criteria, such as having diabetes and high cholesterol, to prevent them from having a major heart event such as a heart attack, stroke, or from requiring heart surgery.

People who have already had a major heart event are also commonly prescribed the drugs, regardless of their age.

What doctors did not know was whether it was safe to prescribe a daily statin to people aged 70 and over who were healthy overall, having never experienced a heart attack, stroke or heart surgery, and whether doing so could prevent these cardiac events.

A co-author of the study, Adjunct Prof Mark Nelson with the Monash University school of public health and preventive medicine, said it was an important piece of missing information, because the biggest risk of major heart-related events “is increasing age”.

“Our society is ageing, and therefore the burden of disease is increasing, making it important to improve our ability to prevent disease in this group,” he said. “So we needed the evidence for this group to see if prescribing statins as a prevention measure works.”

But Nelson said older adults were often overlooked in early statin research because 40 years ago, heart disease was most common in middle-aged populations especially if they smoked, leading public health efforts to focus on preventing premature deaths in that group. Elderly populations may also be sick and on other medications, making trialling drugs risky, he said.

To address the gap, Monash researchers analysed the cardiovascular outcomes of almost 10,000 study participants over the age of 70 who were given either a daily statin or a placebo, in a scientifically-robust type of study known as a randomised control trial. The participants were enrolled with the help of almost 3,400 GPs across Australia.

The researchers excluded people who had a condition that might make taking a statin unsafe, if they were not living independently, or if they already needed the drug because they had suffered a heart attack.

The decade-long study found the medication decreased the risk of a first major cardiovascular event by 30% for those aged over 70.

In real terms, this means one major cardiac event such as a heart attack, stroke, or heart surgery could be prevented for every 37 older adults treated with daily statins over almost six years.

Prof James Chong, a cardiologist at Sydney’s Westmead hospital, said if the research “leads to increased statin use globally, the absolute reduction of (heart-related) events can be significant”.

“One of the major changes that may result, in my opinion, is more elderly patients having confidence to take long term statins,” he said.

“However, one thing we have to keep in mind is it was an almost exclusively white population with the mean age around 75 years of age, so the results may not be as generalisable globally without further supporting evidence.”

The findings were published in the New England Journal of Medicine on Saturday and presented concurrently at the European Society of Cardiology Congress in Germany.

Lead researcher on the paper, Adjunct Prof Sophia Zoungas, said: “What we hope to see, now that we have provided such strong evidence, are updated treatment guidelines to help clinicians make use of this new finding.”

Older patients should have a conversation with their GP about whether statins are appropriate to help them stay healthy, the researchers said.

Prof Tom Marwick, a cardiologist at Hobart’s Royal hospital, said there had been a lot of misinformation about statins increasing the risk of dementia, making some older people reluctant to take the drugs.

A benefit of the Monash study was that the findings “really close the book on that, in large numbers,” he said. The study found no statistically significant difference in dementia rates among those who received a statin and those who did not.

Marwick described it as a “well done, really important trial”.

But he said the study also found patients were reluctant to adhere to therapy, with more than 15% of patients in the trial discontinuing their medication.

Marwick said “a slight disappointment” in the findings was that although major heart events were reduced, the disability-free survival was the same among the participants whether they took the statin or the placebo.

In other words, taking the medication didn’t extend life or its quality.

“We can reduce cardiovascular events, but the health burdens of ageing are less amenable,” he said.