BY THE OPTIMIST DAILY EDITORIAL TEAM
A decade-long clinical trial of nearly 10,000 adults aged 70 and over has found that daily statins reduce the risk of a first major cardiac event by 30 percent, with no significant increase in serious side effects. The study was published in the New England Journal of Medicine and presented simultaneously at the European Society of Cardiology Congress.
Led by Monash University researchers in Australia, the trial is the first randomized controlled trial to test statins specifically as a preventive measure for otherwise healthy adults past 70. That population had been largely absent from the statin research that shaped current prescribing guidelines.
A 40-year gap in the evidence
Statins are already widely prescribed to adults under 75 who meet certain risk criteria and to patients of any age who have already had a cardiac event. Whether they should be given preventively to healthy adults over 70 had not been formally tested.
The gap existed partly for historical reasons. Forty years ago, heart disease was most common in middle-aged smokers, and public health efforts focused there. Older patients, who often had other conditions and took multiple medications, were harder to enroll in trials.
“Our society is ageing, and therefore the burden of disease is increasing, making it important to improve our ability to prevent disease in this group,” said Adjunct Prof. Mark Nelson, a co-author of the study from Monash University’s school of public health and preventive medicine. “So we needed the evidence for this group to see if prescribing statins as a prevention measure works.”
What the trial found
Nearly 3,400 general practitioners across Australia helped enroll participants. Those with conditions making statins unsafe, those not living independently, and anyone who had already had a heart attack were excluded. Participants received either a daily statin or a placebo.
Statins reduced the risk of a first major cardiovascular event, including heart attack, stroke, or cardiac surgery, by 30 percent. One major cardiac event could be prevented for every 37 adults treated over nearly six years.
The trial also found no statistically significant difference in dementia rates between the statin and placebo groups. That matters: concern about a dementia link has been one reason some older patients avoided the drugs. Prof. Tom Marwick, a cardiologist at Hobart’s Royal Hospital, said the findings “really close the book on that, in large numbers.”
What’s the caveat?
The trial found no difference in disability-free survival between the two groups. Statins reduced cardiac events but didn’t extend life or improve its quality. “We can reduce cardiovascular events, but the health burdens of ageing are less amenable,” Marwick said.
More than 15 percent of participants also stopped taking their medication during the trial. And the study population was almost exclusively white, with a mean age of around 75. Prof. James Chong, a cardiologist at Sydney’s Westmead Hospital, noted that “the results may not be as generalizable globally without further supporting evidence.”
What comes next
Lead researcher Adjunct Prof. Sophia Zoungas said the team hoped the findings would prompt updated prescribing guidelines. “What we hope to see, now that we have provided such strong evidence, are updated treatment guidelines to help clinicians make use of this new finding.” For patients, the researchers said, the next step is a conversation with a general practitioner.
Source study: New England Journal of Medicine— Atorvastatin, Cardiovascular Events, and Disability-free Survival in Older Adults
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