New research shows more people can benefit from taking statins than previously believed, including people over 75 years old.
For over two decades, doctors have prescribed a class of drugs called statins to reduce a person’s risk of heart attack and stroke.
Typically, they’re given to people between the ages of 40 and 75, and plenty of studies show that they work well (and safely).
But according to new research published in
Here’s what you need to know.
Statins are drugs that lower your cholesterol, a type of fat in your blood. That’s important, since high blood cholesterol is a risk factor of heart attack and stroke.
If left unchecked, it can cause plaque to build up in your arteries, impeding your blood flow and causing inflammation. And if a fragment breaks loose, it can lead to a heart attack.
“Statins partially block the formation of cholesterol in the liver, which lowers the bad cholesterol (LDL) in your blood,” said Dr. Scott M. Grundy, a volunteer expert from the American Heart Association and professor of internal medicine at the University of Texas Southwestern Medical Center in Dallas.
In doing so, statins actually decrease your chances of a heart attack or stroke.
Typically, these drugs are prescribed to people who’ve already experienced one of these events, but “other people who have risk factors for cardiovascular disease or a high cholesterol level also may benefit,” said Grundy.
While up to 90 percent of people who take statins have zero side effects, the most common complaint from people who do is muscle aches, Grundy noted.
The good news is these can be addressed by decreasing the dose of the drug or switching to a different type of statin. (Although in some cases, people simply stop taking them altogether.)
In the past, there have been some significant concerns about statins — that they can lead to cancer, for instance, or that they can affect your memory.
“These things have been shown not to be true,” said Dr. Robert Greenfield, a cardiologist, lipidologist, and medical director of noninvasive cardiology and cardiac rehabilitation at MemorialCare Heart & Vascular Institute at Orange Coast Medical Center in Fountain Valley, California. “Statins are safe.”
The gist is that statins can help more people than previously believed.
Researchers from Australia and the U.K. looked at evidence from 28 randomized controlled trials and a whopping 186,854 patients — 14,483 of whom were over the age of 75.
What they found was that across all age groups, major cardiovascular events like a stroke or death by coronary heart disease (CHD) decreased 21 percent for each 1 mmol/L drop in LDL, or “bad” cholesterol.
“This new study confirms that this benefit extends to older people over age 75 who have existing cardiovascular disease,” Grundy said.
Until now, doctors have been uncertain on this point because of the lack of clinical trials carried out on this older demographic.
Researchers also noted that deaths from cancer or nonvascular causes weren’t any higher in statin users than they were in people who didn’t take the drug, meaning that statins do appear safe for older people to take.
“You’d never write someone off based on age alone, but older people usually have more medical conditions and you have to take that into account,” explained Greenfield.
“It’s always an individual decision between physician and patient, but we can now tell older people, ‘You can benefit, too.’”
Until now, “most guidelines on cholesterol treatment have been cautious about recommendations for cholesterol-lowering with statins in older people,” Grundy explained.
“Too few studies have been carried out to demonstrate benefit.”
Now, doctors may feel more confident in prescribing statins to older people. And, noted Greenfield, because the new generation of statins are even more potent than the types studied in the Lancet research, “they could lower bad cholesterol even more.”
Not all of us.
“Statins should not be used in everyone, whether middle-aged or elderly,” said Grundy. “Treatment requires good clinical judgment by a qualified physician.”
It’s important to distinguish between secondary and primary prevention with statins, Grundy noted.
“Secondary prevention” means giving statins to people who already have heart disease. “The results of the current study speak mainly to secondary prevention, where statin therapy in older people is shown to be beneficial,” Grundy said.
“Primary prevention,” on the other hand, means treating people who may be at risk for heart disease in the future, but who aren’t currently showing any evidence of the disease.
Statins have already proven to be beneficial for middle-age people at risk, and this study underscores that fact.
When you’re younger, any plaques beginning to develop in your arteries are still immature. Statins don’t have a magic ability to clean them out.
“They’re not Drano,” noted Greenfield, “but they can stabilize the plaques so they don’t rupture.”
On the other hand, if you’ve had plaques in your arteries for decades, they’re likely to be firmer and more solid — and less reversible.
If doctors treated people earlier, Greenfield added, “maybe we wouldn’t be on so many medicines later on in life. If we can stop these processes in their early phase, that’s a great insurance policy.”
More studies need to be done to prove how effective statins are as a primary prevention for the older demographic. “The current study shows a trend for benefit, but did not give a conclusive result,” Grundy said.
Because of that, it’s up to a doctor to decide whether to start an older person on statins who appears to be at risk.
According to Grundy, “Most experts would favor continuing statin treatment as a middle-age person slips into the elderly period.”
“Age is just a number,” agreed Greenfield. “If someone is vital, alert, and has the will to live and enjoy life, they want to be healthy, too. Statins could clearly be a way that makes that happen.”