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Statins questioned for primary prevention in elderly

People over 65 who start statin therapy for primary prevention may risk hastening their deaths, according to new research published in JAMA Internal Medicine.

The study findings are based on an analysis of a randomised trial of pravastatin that took place from 1994 to 2002. The researchers looked at a trial subset of nearly 3000 people over 65 who had no baseline atherosclerotic cardiovascular disease but had raised cholesterol.

In this group, those randomised to pravastatin had similar rates of cardiovascular heart disease compared with those on usual treatment. Rates of stroke, heart failure and cancer were all about the same across the two groups as well.

But more deaths were reported in the pravastatin group compared with usual treatment – 141 vs 130 in patients aged 65 to 74, and 92 vs 65 in those aged 75 and over.

“No benefit was found when a statin was given for primary prevention to older adults. Treatment recommendations should be individualised for this population,” the authors write.

They suggest that statins in this age group may trigger “untoward effects in the function or health of older adults that could offset any possible cardiovascular benefit”.

They note that some studies have suggested statins can increase fatigue with exertion and may negatively impact on cognition, particularly in people with mild cognitive impairment or dementia.

They also point to observational studies that have had mixed findings regarding the benefit of statins for primary prevention in older people.

But not everyone accepts the finding of the current study.

Professor Jeremy Pearson, who is the Associate Medical Director of the British Heart Foundation, notes that the statin used in the study, pravastatin, is no longer prescribed to lower cholesterol and has since been replaced by stronger statins.

“This could have an impact on the results, so more research is needed to confirm the findings, based on current best practice,” he says.

And Dr Tim Chico, a consultant cardiologist at the University of Sheffield in the UK, said that to study the effectiveness of primary prevention you would need many more than the subset of 3,000 patients examined in the study.

You can read the full paper here.