When deciding to start or stop statin therapy, older adults need to weigh the benefits and risks of this cholesterol-lowering medication.
Doctors recommend cholesterol-lowering statin drugs for many people who are healthy but who have a higher risk for cardiovascular disease.
But, much of the evidence for this is based on clinical studies done in people under age 75.
For older adults it’s been less clear if the benefits of statins, which include preventing heart attacks and strokes, actually outweigh the risks of the medication, which include muscle and cognitive problems.
But now a new study has shed light on the benefits and risks of people over 75 taking this medication. It found that older adults who stopped taking statins had a higher chance of developing heart or blood vessel problems.
Some experts point to this as support for continued use of statin therapy after age 75, but others advise caution.
The study, which was published July 30 in the European Heart Journal, included health insurance claims information on more than 120,000 people in France who were 75 years old between 2012 and 2014.
Researchers included only older adults who had been taking a statin medication for at least two years. During the study period, more than 17,000 people stopped their statin therapy, but almost half of them resumed before the end of the study.
Older adults who stopped taking statin medication had a 33 percent increased risk for being admitted to the hospital for a heart or blood vessel problem during the follow-up period, which was 2.4 years on average.
Dr. Guy L. Mintz, director of cardiovascular health and lipidology at Northwell Health’s Sandra Atlas Bass Heart Hospital in Manhasset, New York, says the study reinforces that older adults shouldn’t stop taking their statin just because they reach the “magic age” of 75.
“This is an important study because it highlights the importance of statin therapy for older adults,” said Mintz, who wasn’t involved in the study. “Statins don’t just lower cholesterol. They also stabilize cholesterol plaque and reduce inflammation.”
Dr. Teresa Amato, chair of emergency medicine at Long Island Jewish Forest Hills in Queens, New York, points out that because the study was observational — where a group is observed as opposed to a randomized clinical trial, where one group may be given a different treatment — the results should be viewed with caution.
“While the data looks like it would suggest that physicians recommend that older people remain on statin medication, we should wait before making that a conclusive recommendation,” Amato said.
The results of previous randomized clinical trials is also mixed. One
Statins also have potential side effects for older adults, such as muscle pain or weakness, which can contribute to frailty.
“And there’s an association for increased cognitive dysfunction in older people who take statins,” Amato said. “These side effects could lead to falls, injuries, and hospitalizations.”
She says right now there’s no clear-cut answer for at what age the risks of statins outweigh the benefits.
Although only a handful of studies have looked at the benefits of statins for older adults, Mintz says current guidelines for cholesterol management don’t say people should stop taking a statin just because they turn 75.
The 2018 American College of Cardiology and American Heart Association guidelines offer recommendations for statin therapy in people over 75 years old.
Among older adults without cardiovascular disease, those with LDL (bad) cholesterol of 70 to 189 mg/dL may benefit from starting a moderate-intensity statin, according to the guidelines.
“Moderate-dose statin therapy is recommended to start because of a lower incidence of side effects in older people,” Mintz said. The dose can be increased for people with a higher risk for developing cardiovascular disease.
However, there are times when the risks of statin therapy may outweigh the benefits.
“The guidelines also state that if an elderly person is frail — with significant mental and physical deterioration — discontinuing statin therapy may be reasonable,” Mintz said.
He suggests that older adults talk to their doctor so they can understand why the use of statins is important, as well as potential side effects.
This includes looking at their risk factors for heart attack and stroke, such as kidney disease, diabetes, peripheral vascular disease, and inflammation.
A doctor may also recommend a coronary calcium scan. This test measures certain types of plaques inside the arteries of the heart.
Although the new study provides support for the use of statins in older adults, it isn’t the final answer.
“While many are using this article to claim that statins in people over 75 are completely beneficial, more studies are needed before a conclusion can be made,” Amato said.
But for some people, after consulting with their doctor, taking statins may be the right choice for them.
“My oldest patient is 100 years old, had coronary artery bypass surgery 20 years ago, remains on statin therapy, and still sings in the church choir,” Mintz said.