The conclusion of the study described is not new. A strength of the study is the large sample of older people at increased risk of cardiovascular disorders, derived from the ALLHAT-LTT study. A methodological limitation of the study is that it involves a post-hoc subgroup analysis, with an increased risk of biased outcomes. Hence, the outcome of a secondary analysis can only generate hypotheses. Obviously, the outcomes do not apply to patients who have started using statins before age 65.
The authors as well as the JAMA commentator associate the possibly elevated mortality risk for those aged 75 and over using statins with the muscular complaints attributed to statins, which could contribute to a loss of functions, risk of falls and excess mortality, especially in this vulnerable category of patients. 4 6
At this moment in time, it would appear wise to be reticent about prescribing statins to older persons as a primary prevention of arterial diseases. A large-scale study that is currently being undertaken in Australia could provide more clarity about their efficacy.
- Brugts JJ, et al. The benefits of statins in people without established cardiovascular disease but with cardiovascular risk factors: meta-analysis of randomised controlled trials. BMJ 2009; 338: b2376.
- Tayler F, et al. (Cochrane Heart Group). Statins for the primary prevention of cardiovascular disease. Cochrane 2013: 10.1002/14651858.CD004816.pub5.
- Via: https://www.gezondheidsraad.nl/sites/default/files/grpublication/achtergronddocument_cholesterolverlagers_voor_iedereen.pdf.
- Gurwitz JH, et al. Statins for primary prevention in older adults: uncertainty and the need for more evidence. JAMA 2016; 316: 1971-1972.
- Curfman G. Risks of statin therapy in older adults. JAMA Intern Med. 2017; 177:966.
- Via: https://www.knmp.nl/links/stichting-farmaceutische-kengetallen-sfk-nl. Stichting Farmaceutische Kengetallen.
- Han BH, et al. Effect of statin treatment vs usual care on primary cardiovascular prevention among older adults: The ALLHAT-LLT randomized clinical trial. JAMA Intern Med. 2017; 177: 955-965.
*The literature refers to the Dutch text