Statins significantly reduce the incidence of myocardial infarction and stroke, but do not significantly prolong short-term survival rates in subjects ages 65 and older who are at high cardiovascular risk without established disease, a meta-analysis found.
Researchers reviewed eight randomized, controlled trials enrolling nearly 25,000 people, nearly 13,000 randomized to statins and more than 12,000 to placebo, and reported their results in the Journal of the American College of Cardiology.
Myocardial infarction occurred in 2.7% of subjects taking statins compared to 3.9% of those in placebo during a mean follow-up of 3.5 years (relative risk [RR], 0.606; 95% confidence interval [CI], 0.434 to 0.847; comparison, P=0.003; heterogeneity, P=0.028. The annual myocardial infarction rate was 1.1% in patients taking placebo and the number needed to treat was 24 patients treated for 1 year to prevent 1 event.
Stroke was reported in 2.1% of subjects randomized to statins compared to 2.8% in placebo during follow-up. Statins significantly reduced the risk of stroke (RR, 0.762; 95% CI, 0.626 to 0.926; comparison P=0.006; heterogeneity P=0.130). The annual rate of stroke was 0.8% in patients randomized to placebo and the number needed to treat was 42 patients for 1 year to prevent 1 event.
Statins did not significantly reduce the risk of all-cause death compared to placebo (RR, 0.941; 95% CI, 0.856 to 1.035; comparison, P=0.210; heterogeneity, P=0.570) or cardiovascular death (RR, 0.907; 95% CI, 0.686 to 1.199; comparison P=0.493; heterogeneity, P=0.831).
There was no difference in the rates of cancer (RR<0.989; 95% CI, 0.851 to 1.151; P=0.890).
Because the on-treatment mean LDL cholesterol remained above the recommended target of 100 mg/dL, higher benefit could be achieved if the current recommend targets are reached. However, researchers noted, identifying high-risk elderly patients without established cardiovascular disease “remains challenging” since calculation of absolute cardiovascular risk over 10 years does not apply to subjects older than 80.
An editorial noted, “The consequences of MI and stroke are much more serious for older than younger patients, both for death and long-term disability. The incidences of CV events also increase with increasing age. For these reasons, the elderly without evidence of atherosclerosis and their caregivers face a high stakes decision on statin treatment, with no clear direction from current guidelines.”
However, it continued, “Older people differ more among themselves than younger ones do, and the decision to treat or not treat an older individual with a statin often requires clinical discernment. The clear results of this meta-analysis will hopefully lead to more older individuals receiving treatment that will reduce their CV risk.”