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How Does Age Affect Statin Benefits?

Statin therapy significantly lowers the risk of vascular events in adults over 70 years of age with a history of vascular disease, according to the results of a new study.
While statin therapy has been shown to reduce the risk of major vascular events and vascular mortality, its effects in older adults are less well understood.
To explore this further, researchers conducted a meta-analysis of 22 randomized trials including 134,537 participants and data detailing statin therapy versus control, along with individual data from 5 trials of more intensive versus less intensive statin therapy (n=39,612).
Participants were divided into 6 age groups (55 years or younger, 56–60 years, 61–65 years, 66–70 years, 71–75 years, and older than 75 years), and risk of major vascular events, cause-specific mortality, and cancer incidence were estimated and compared among the age groups. A total of 14,438 of 186,854 total participants were aged older than 75 years at randomization.  
Overall, statin therapy and more intensive statin regimens were associated with a 21% (rate ratio [RR] 0.79) proportional reduction in major vascular events per 1.0 mmol/L reduction in LDL cholesterol, and significant reductions were observed in all age groups. While these reductions diminished with age, the trend was not statistically significant. Statin therapy was associated with a 24% (RR 0.76) proportional reduction in major coronary events per 1.0 mmol/L reduction in LDL cholesterol.
While the reduction in major vascular events was similar regardless of age among patients with preexisting vascular disease, the researchers noted that it appeared smaller among adults without known vascular disease.
“In conclusion, statin therapy produces significant reductions in major vascular events, irrespective of age. There is less definitive direct evidence of benefit in the primary prevention setting among patients older than 75 years, but evidence supports the use of statin therapy in older people considered to have a sufficiently high risk of occlusive vascular events,” they wrote.

REFERENCES:
Cholesterol Treatment Trialists’ Collaboration. Efficacy and safety of statin therapy in older people: a meta-analysis of individual participant data from 28 randomised controlled trials [published online February 2, 2019]. Lancet. doi:https://doi.org/10.1016/S0140-6736(18)31942-1.

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