Re: Statins for primary prevention of cardiovascular events and mortality in old and very old adults with and without type 2 diabetes: retrospective cohort study
The analysis of Ramos et al (1) about starting statin treatment in primary prevention among people aged 75 years or more is important and gives valuable advice in a situation where specific randomised trials are lacking. However, I am afraid the study gives a misleading message about statin treatment overall among people older than 74 years. Ramos et al specifically investigated the effect of starting – not already using --a statin in old age. The study does not indicate that a statin started earlier in life should be discontinued when one turns 75 years. Still, many people may interpret the results of Ramos et al. that way, especially when the Conclusions end: “these results do not support the widespread use of statins in old and very old populations…” I think a better conclusion would have been: “the results do not support STARTING a statin in clinically healthy people without diabetes and aged 75 or more”. In people at cardiovascular risk statin treatment should be started well before 75 years.
Whether ongoing statin treatment is or is not worth discontinuing in old age can only be proven by ‘deprescribing’ trials. The ethical side of such trials should, however, be carefully considered given the better prognosis of current statin users in several observational studies (2,3), the overall safety of statins also in older patients (3), and preserved health-related quality of life among octogenarians using statins (4).
1. Ramos R, Comas-Cufí M, Martí-Lluch R, et al. Statins for primary prevention of cardiovascular events and mortality in old and very old adults with and without type 2 diabetes: retrospective cohort study. BMJ. 2018 Sep 5;362:k3359. doi: 10.1136/bmj.k3359
2. Strandberg TE. Deprescribing statins-is it ethical? J Am Geriatr Soc. 2016;64:1926-7. doi: 10.1111/jgs.14270
3. Strandberg TE, Kolehmainen L, Vuorio A. Evaluation and treatment of older patients with hypercholesterolemia: a clinical review. JAMA. 2014;312:1136-44. doi: 10.1001/jama.2014.10924.
4. Strandberg TE, Urtamo A, Kähärä J, Strandberg AY, Pitkälä KH, Kautiainen H. Statin treatment is associated with a neutral effect on health-related quality of life among community-dwelling octogenarian men. J Gerontol A Biol Sci Med Sci. 2018 Apr 12. doi: 10.1093/gerona/gly073. [Epub ahead of print]
Competing interests: I have had various cooperation (research, education, consultative) with companies and entities interested in lipid-lowering treatments. I follow a heart-healthy diet and take a statin daily.