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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; 362 doi: (Published 05 September 2018) Cite this as: BMJ 2018;362:k3359

Linked Editorial

Primary prevention with statins for older adults

Please remember the possibility of reverse causality in observational studies

Dr. Saripanidis wonders whether statins would be harmful in older people. Frequently quoted reports of the epidemiological association of low cholesterol and mortality risk in old age keep causing confusion and false interpretations. The association is due to reverse causality (terminal decline lowers cholesterol, 1), and does by no means indicate, nor prove, that THERAPEUTIC reduction of cholesterol --by eg. statins -- would be harmful. In analogy, patients with hyperthyreosis or cancer have often both low cholesterol levels and increased mortality risk, but in those cases everyone realises that increased mortality is caused by the baseline condition – not lowered cholesterol !

1. Charlton J, Ravindrarajah R, Hamada S, Jackson SH, Gulliford MC. Trajectory of Total Cholesterol in the Last Years of Life Over Age 80 Years: Cohort Study of 99,758 Participants. J Gerontol A Biol Sci Med Sci. 2018;73:1083-1089. doi: 10.1093/gerona/glx184.

Competing interests: As earlier reported. I still keep taking a statin despite being >60 years.

12 September 2018
Timo E Strandberg
University of Helsinki and Helsinki University Hospital; University of Oulu
PO Box 340, FIN-00029 Helsinki