Statin therapy reduces the risk of major cardiovascular events, regardless of age – ScienceDaily

Regardless of their age, statins reduce the risk of major vascular events by about one-fifth to 1 mmol / L of LDL cholesterol reduction. For major coronary events, the overall reduction was about a quarter by 1 mmol / L reduction, but it ranged from about 30% in the elderly. <55 years to around 20% in those aged >75. The relative risk reductions from stroke and coronary revascularization (coronary stent or coronary bypbad graft) were similar in all age groups.

Dr. Jordan Fulcher of the CTT collaboration, based at the NHMRC Clinical Trials Center at the University of Sydney, Australia, said: "Statins are a useful and affordable medicine that can reduce heart attacks and heart attacks. Stroke in Elderly Patients There is now a lack of evidence and we wish to examine their efficacy and safety in the elderly: our badysis indicates that major cardiovascular events have been reduced by about one-fifth, per mmol / L, Lower LDL Cholesterol, by Statin Treatment in All Age Groups Despite the concerns expressed previously, we found no adverse effects on cancer or non-vascular mortality in any age group. "

Statins are cholesterol-lowering drugs widely prescribed to patients at increased risk of heart attack or stroke. Evidence from randomized trials has shown that statin therapy reduces this risk in a wide range of people, but there is uncertainty about the benefits for the elderly.

In the past, trials of the effect of statin therapy reported a significant reduction in cardiovascular risk in the 65 to 70 age group, but questions arose as to their benefit in older patients, particularly those in the elderly. over 75 years old. Statin therapy is often discontinued in elderly patients. partly because of this question about risks and benefits.

The investigator collaboration for cholesterol treatment examined 23 trials comparing statin therapy with one control group and five trials of intensive therapy versus statin therapy. They divided the patients into six age groups and studied the effects on major vascular events (including major coronary events, stroke, and coronary revascularizations), cancer incidence, and mortality. specific.

Of the 186,854 test participants examined, with an average age of 63, 14,483 were over 75 years of age.

The badysis shows that the reduction of major vascular events – 21% for 1 mmol / L of overall LDL cholesterol – is similar and significant in all age groups, including those over 75 years old. For major coronary events, the overall reduction is 24% by LDL reduction of 1 mmol / L, but decreases slightly with age. The study also shows no increased risk of death or non-vascular cancer in any age group.

The researchers noted that four trials conducted exclusively with patients with heart failure or kidney dialysis had influenced their results. Statins have not been effective in these people and are not recommended. When these participants were excluded, similar reductions in risk were observed in all age groups, including major vascular events and cardiovascular mortality. A slightly less significant reduction in the risk of major coronary events with increasing age persisted.

The research also examined the effects of statins on major vascular events in people with a history of vascular disease (secondary prevention) and in people without known vascular disease (primary prevention). In secondary prevention, researchers found similar proportional risk reductions, regardless of age, which is equivalent to higher absolute benefit for the elderly. In the primary prevention setting, the results were similar, but as there were fewer older participants in the trials, the conclusions were less specific. More evidence from randomized trials in older people without previous vascular disease will be useful and trials are ongoing.

In primary prevention (ie, in people with no known history of vascular disease), two people aged 63 and 78 years with otherwise identical risk factors could have major vascular event rates. 2.5% vs. 4.0% annually, respectively. A reduction of one-fifth of these risks through a reduction of 1.0 mmol / L of LDL cholesterol would prevent the first major vascular events occurring each year in 50 people aged 63 and 80 people aged 78 per 10,000 people treated.

In secondary prevention (with a known history of vascular disease), the absolute risks of a major vascular event are usually at least twice as great. Thus, each year, the same reduction in LDL cholesterol in people with previous vascular disease would prevent a first major disease. vascular events in at least 100 people aged 63 years and at least 160 people aged 78 years out of 10,000 people treated.

The present badyzes focused on the effects of statin therapy on major vascular events, mortality and cancer, and the authors limited their meta-badysis to large-scale trials, known to generate the most reliable evidence. Previous studies have shown that the benefits of statins outweigh the risk of other adverse effects (such as myopathy), and ongoing work in this area is being carried out through collaborative trials. clinics on the treatment of cholesterol.

Bernard MY Cheung, Queen Mary Hospital, University of Hong Kong, writes in a related commentary: "Although risk reduction for people over 75 years of age is below expectations, statin therapy still be justified by a high cardiovascular risk initially. This meta-badysis advocates reducing LDL cholesterol in people at risk for cardiovascular events, regardless of their age, provided that the benefits outweigh the risks and the patient agrees to treatment with long term. "

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