Older adults should consider statins for better health

• Statins are a type of medication that can help lower a person’s “bad” cholesterol, helping reduce their risk for cardiovascular disease.
• Statins are generally recommended for adults between the ages of 40 and 75 who have heart disease risk factors.
• Despite having higher risks for cardiovascular disease, fewer older adults use statins.
• Researchers from the University of Oxford found statin treatment was both cost-effective and correlated to better health outcomes in older adults with or without previous cardiovascular disease.

The U.S. Preventive Services Task Force (USPSTF) recommends adults between the ages of 40 to 75 who have one or more cardiovascular risk factors and an estimated 10-year cardiovascular disease risk take statins to help prevent heart issues.

But what about older adults over the age of 70 — can statins help them as well?

“Despite high risks of heart disease and stroke in older people and high need for preventive treatment such as statins, fewer older people use statins compared to middle-aged people,” Borislava Mihaylova, DPhil, associate professor and senior health economist at the Nuffield Department of Population Health at the University of Oxford, professor of Health Economics in the Wolfson Institute of Population Health at Queen Mary University of London told Medical News Today.

“This is likely due to fewer older people, particularly those without previous heart attacks and strokes, contributing to the randomized studies of statin therapy which has led to more limited evidence with larger uncertainty,” she said.

For this reason, Mihaylova and her colleagues decided to re-examine the value of statin therapy for older adults using the latest evidence and contemporary population data.

In the new study recently published in the journal Heart, lead author Mihaylova and her team found statin treatment was both cost-effective and correlated to better health outcomes in older adults with or without previous cardiovascular disease.

For this observational study, researchers analyzed data from the U.K. Biobank and Whitehall II study of more than 20,000 adults in the U.K. 70 years and older with or without previous cardiovascular disease.

This data was then used in the cardiovascular disease simulation model to estimate study participants’ heart disease risk, survival rate, quality-adjusted life years, and healthcare costs with and without lifetime standard or higher intensity statin therapy.

“Heart disease and stroke are leading causes of disability and death,” Mihaylova said. “As we age, our risk of having a heart attack or a stroke increases. Having high levels of LDL or ‘bad’ cholesterol in your blood further increases your risk. Statins are a type of medicine that lower levels of LDL cholesterol and reduce risk of heart attacks and stroke.”

According to researchers, standard statin therapy normally results in a 35-45% reduction in LDL cholesterol, while higher-intensity treatment lowers LDL cholesterol by 45% or more.

Upon analysis, scientists found that participants who stayed on standard statin treatment for their lifetime increased their quality-adjusted life years by 0.24-0.70, and those on higher-intensity statin therapy raised their quality-adjusted life years by another 0.04-0.13.

“We previously looked into the effects of statin therapy in middle-aged people,” Mihaylova said.

“The effects of statin therapy reported here across people 70 years of age and older are, as expected, a bit smaller but sizeable. These results complete the picture of likely substantial health benefits with statin therapy across the continuum of age and risk levels in the population,” she continued.

When examining the cost-effectiveness of statin use in older adults, the researchers report that statins were cost-effective, with the cost per quality-adjusted life years gained below £3,502 (about $4,560) for standard therapy and below £11,778 (about $15,340) for higher intensity therapy.

This, the scientists say, is well under the current threshold for good value interventions of about £20,000 (about $26,000) per quality-adjusted life years gained.

“This finding indicates that statin treatment is likely to be of good value-for-money across people over 70 years old,” Mihaylova explained.

“The additional cost for the additional health gained with statin therapy is well under what is considered ‘good buy’ for the NHS. It was also reassuring to see that statins remained of good value — although with greater uncertainty — in further analysis assuming smaller risk reductions with statin therapy in older people without previous cardiovascular disease. Overall, our findings suggest that more people over 70 years of age should be considered for statin treatment.”
— Borislava Mihaylova, DPhil

“Cardiovascular disease remains a leading cause of disability and death. In addition to statin treatment, people at high cardiovascular risk need further effective and cost-effective treatments to reduce their risks. We are currently studying such treatments — how well they work and whether they are of good value for (the) money in categories of people, including older people,” she said.

MNT also spoke with Yu-Ming Ni, MD, a board certified cardiologist and lipidologist at MemorialCare Heart and Vascular Institute at Orange Coast Medical Center in Fountain Valley, CA, about this study.

“This is not really surprising,” Ni said. “We’ve known for a very long time that statins prevent heart disease. They’re especially effective for patients who already have heart disease to prevent a recurrent event — that means another heart attack, stroke, or leg artery blockage. Patients benefit from these medications by reducing their risk for events, it improves the quality of life, and reduces symptoms from those events, and the result is that people live longer and healthier.”

“It seems clear to me from this study it appears that patients still get a benefit from being on a statin into their 70s. Something that I took away from this (study) is that patients who are on statins already with prior cardiovascular disease stand to maintain their benefit as they continue through into their 70s. And I think that’s important because we often ask ourselves whether we really need to take this medication as we’re getting older and there are other competing factors, other medical admissions.”
— Yu-Ming Ni, MD

“We know that a lot of people, as you get older, take a lot of medications. They can get tired of taking pills, but this study helps to suggest that the benefit from the statin persists, so those who already have heart disease should continue to take their medication unless there’s a strong reason to stop the statin. I generally recommend continuing taking the statin well into older years,” Ni added.