January 31, 2019

expert reaction to meta-analysis looking at statins and cardiovascular events in all ages

Reactions to meta-analysis published in The Lancet which claims Statin therapy causes reductions in vascular events regardless of age. There is less evidence of benefit among patients older than 75 who do not already have vascular disease.

Prof Naveed Sattar, Professor of Metabolic Medicine, University of Glasgow, said:

“Despite many doubters on the benefits of statins, the accumulated trial data, which are the best available evidence anywhere, convincingly show statins meaningfully lower risks across nearly all age groups, and do so safely.  Heart attacks and stroke risks were reduced even when statins were prescribed to people above 75 if they had prior heart disease or strokes.  In older people who do not have existing disease, further trials are needed to determine if the overall benefits are sufficient to make firm recommendations so this remains a grey area, as does when to consider stopping statins in the very elderly.  But for all other groups, statins do what they say on the tin – they lower LDL-cholesterol and so lower risks for heart attacks and strokes.”

Prof Sir Nilesh Samani, Medical Director at the British Heart Foundation, said:

“Concern has been raised about the benefits of statins in older people.  This large analysis provides powerful evidence that statins reduce heart attacks and strokes in older people, as they do in younger people, and are safe.

“Age should not be a barrier to prescribing these potentially life-saving drugs to people who are likely to benefit.”

Prof Liam Smeeth, Professor of Clinical Epidemiology, London School of Hygiene & Tropical Medicine, said:

“This is a very high quality piece of research drawing together all the data we have to answer a focussed question: whether the beneficial effects of statins vary at different ages.  The data used all came from robust randomised controlled trials, the best study design we have to assess the effects of a drug.

“This analysis clearly demonstrates that the benefits of statins in preventing heart attacks and strokes are seen across the full age range.

“Over the years the numbers of older people, particularly those aged over 75, included in randomised trials of statin therapy have been quite small.  This has limited our ability to be certain about the effects of statins in the oldest age groups.

“It remains possible that the beneficial effects of statins are a little less pronounced among the oldest age groups, particularly among people with no existing vascular disease.  However, a protective effect against heart attacks and strokes is still seen among older people, and patients need to be offered statins irrespective of age.

“Future studies including larger numbers of older people without pre-existing cardiovascular disease will help us become more certain about the effects of statins among older people.”

Prof Peter Sever, Professor of Clinical Pharmacology & Therapeutics, Imperial College London, said:

“This is a very important meta-analysis of the statin trials in which outcomes were assessed across the adult age range.  The strength of this analysis is that it contains data on over 14,000 patients over 75 years of age.

“The benefits of statins in reducing cardiovascular events continue through into elderly age groups – these age groups are at high risk of cardiovascular disease, and so benefits are substantial.  The study outcomes provide a clear indication that statins should be prescribed in elderly patients when they meet the risk threshold given by NICE guidance but observational studies in clinical practice indicate that this group of patients are undertreated.”

Efficacy and safety of statin therapy in older people: a meta-analysis of individual participant data from 28 randomised controlled trials’ by the Cholesterol Treatment Trialists’ Collaboration was published in the Lancet at 23:30 UK time on Thursday 31 January 2019.

Declared interests

Prof Naveed Sattar: “Naveed Sattar has consulted for Amgen and Sanofi.  He is named as collaborator on this paper (in the ‘CTT Collaborators contributing trial data to analyses in this paper’ section) as has ongoing involvement in the PROSPER (Prospective Study of Pravastatin in the Elderly at Risk) and WOSCOPS (West of Scotland Coronary Prevention Study) trial study groups.”

Prof Sir Nilesh Samani: “BHF part-funded this study.”

Prof Liam Smeeth: “Professor Smeeth reports grants from Wellcome, MRC, NIHR, BHF, Diabetes UK, ESRC and the EU; grants and personal fees for advisory work from GSK, and personal fees for advisory work from AstraZeneca. He is a Trustee of the British Heart Foundation and a member of the steering committee for UK Biobank. He is the principal investigator of the NIHR funded StatinWise trial established to investigate whether statins cause muscle symptoms.”

Prof Peter Sever: “ASCOT data (my trial) will have been included in the data base for this trial but I played no part in analyses or writing of the paper.  I’ve received grant funding, honoraria and consultancies from Pfizer and Amgen.”