Should a 76-year-old who doesn’t have heart disease, but does have certain risk factors for developing it, take a statin to ward off heart attacks or strokes?
You’d think we’d have a solid answer to this question. These widely prescribed medications lower cholesterol to reduce cardiovascular disease, the nation’s most common killer, and get much of the credit for the nation’s plummeting rates of heart attacks and strokes.
When they entered common use in the 1990s, “it was very exciting,” said Dr. Ariela Orkaby, a geriatrician at the Harvard Medical School and lead author of a new study on statins in older adults. “Suddenly you had a drug that could reduce the risk of heart attack and stroke by 20 or 30 percent or more.”
So current medical guidelines recommend statins for people in that no-heart-disease category, a strategy called primary prevention — but only for those up to age 75. Yet almost half of adults aged 75 and older take statins, the Centers for Disease Control and Prevention has reported.
Some of those people probably are taking drugs that aren’t helping and can cause problems, researchers and geriatricians say. On the other hand, some older patients who likely would benefit from statins aren’t taking them.
“This is a situation that makes most doctors very uncomfortable,” said Dr. Sei Lee, a geriatrician at the University of California, San Francisco. “Some feel these drugs have been successful used in younger patients, so why not use them?”
So why not? “We don’t have good specific data for people without known heart disease over age 75,” Dr. Lee said. “Are statins helpful or harmful for them? The honest answer is, we don’t know.”
To be clear: Statins make sense for adults of any age who already have heart disease, who have suffered a heart attack or stroke, or who have had arteries unblocked with a procedure like stenting. This is called secondary prevention.
In 2013, the American College of Cardiology and the American Heart Association issued a series of statin recommendations for primary prevention, relevant to adults up to age 75 who have high cholesterol or diabetes, or who for other reasons face an estimated 7.5 percent risk or greater of developing heart disease within 10 years.
Last year, the United States Preventive Services Task Force similarly recommended statins for primary prevention in people aged 40 to 75 who had risk factors like high cholesterol, diabetes, high blood pressure or smoking, with a 10-year disease risk of 10 percent or greater.
But for people over age 75, both panels agreed, there was not sufficient evidence to reach a conclusion. As with many clinical trials, the major statin studies mostly haven’t included patients at advanced ages.
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