Benefits seen in those with type 2 diabetes aged between 75 and 84

A new study has found that statins (drugs used to reduce cholesterol) are not associated with a reduction in heart disease, stroke or death in healthy older people aged over 75. However, they were of benefit to older people with type 2 diabetes.

The Spanish study, which is published in the BMJ, therefore does not support the widespread use of statins in old and very old people, but it does support treatment in selected people, such as those aged between 75 and 84 with type 2 diabetes.

Cardiovascular disease is the leading cause of death worldwide, especially for those aged 75 and over. Statin prescriptions to elderly patients have increased in recent decades, and research supports statin treatment for people aged 75 years or older with existing heart disease (known as secondary prevention).

However, evidence on the effects of statins for older people without heart disease (known as primary prevention) is lacking, particularly in those aged 85 years or older and those with diabetes.

So, researchers set out to assess whether statin treatment was associated with a reduction in cardiovascular disease and death in old (75-84 years) and very old (85 years and over) adults with and without type 2 diabetes.

They identified 46,864 people aged 75 years or more with no history of cardiovascular disease between 2006 and 2015.

They then grouped these people into those with and without type 2 diabetes and as those that did not use statins or new users (anyone starting statins for the first time during the study enrolment period).

Primary care and hospital records were then used to track cases of cardiovascular disease (including coronary heart disease, angina, heart attack and stroke) and death from any cause over an average of 5 and a half years.

The results revealed that in those without diabetes, statin treatment was not associated with a reduction in cardiovascular disease or death from any cause in both old and very old age groups.

In people with diabetes, however, statins were associated with significantly reduced levels of CVD (24%) and death from any cause (16%) in those aged 75-84 years. However, this protective effect declined after the age of 85 and disappeared by age 90.

The authors stated that as this was an observational study, no firm conclusions could be drawn, and they added that they could not rule out the possibility that some of their results may be due to unmeasured factors.

However, they pointed out that this was a high-quality study with a large sample size, reflecting real life clinical conditions.

A such, they concluded that their results did not support the widespread use of statins in old and very old people but did support their use in people with type 2 diabetes younger than 85 years.

Commenting on the study Dr Angie Brown, Medical Director of the Irish Heart Foundation said “Statins have been proven in many large-scale randomised trials to be beneficial for both secondary prevention (following a stroke or heart attack etc) and primary prevention in patients with a significant risk of developing cardiovascular disease such as in patient with diabetes. However, there is less evidence for effectiveness in patients over 80 years of age.

“The current study suggests no benefit of statins in healthy people over 75 years of age but did show a significant benefit in patients with diabetes. As this is an observational study no firm conclusions can be drawn as some of their results may be due to unmeasured factors.  As age is a dominant driver of risk we know the biggest challenge for clinicians is how to more appropriately stratify risk in individuals aged more than 75 years of age.

The observational findings of this need to be tested further in randomised trials.  In the meantime, it’s important that patients continue with their medication as prescribed and discuss their particular situation with their doctor if they have any concerns.”