Lipid lowering for primary prevention of stroke in older adults?

Vascular events of the heart (myocardial infarction) and brain (stroke) are the world’s leading cause of death and disability. Most events occur in older people without previous symptomatic vascular disease. Although this group has a lower relative risk of vascular events than people with a previous history, they are substantially more prevalent and so account for a greater absolute number of events.1

Strategies to reduce the burden of vascular events include lipid lowering with statins. Every 1.0 mmol/L reduction in low density lipoprotein cholesterol reduces major vascular events by one fifth in populations of mean age 63 years, among whom many (60%) have previous vascular disease.2 The absolute benefit of statins is also proportional to the absolute risk of vascular events,2 so guidelines recommend adding statins to lifestyle changes if the 10 year risk exceeds 7.5-10%.3 4 Nevertheless, guidelines do not generally recommend statins for adults aged over 75 years without vascular disease because robust evidence is limited.5 6 7

In a linked paper (doi:10.1136/bmj.h2335), Alpérovitch and colleagues report that use of statins or fibrates to lower serum cholesterol was associated with a one third lower risk of stroke …