Statins a treatment for most at any age

DearDrRoach: You seem to promote statins. How about statins for older people? A recent study from 2017 that appeared to be peer reviewed and well done found “no benefit was found when pravastatin was given for primary prevention to older adults with moderate hyperlipidemia and hypertension, and a nonsignificant direction toward increased all-cause mortality with pravastatin was observed among adults 75 years and older.” Is this a significant result? — R.B.R.

DearR.B.R.: I do recommend statin drugs for people at a higher risk for heart disease and stroke, but only after a comprehensive look at all of their risk factors. Often, the risk can be lowered by changing lifestyle, especially diet and exercise. Sometimes the risk can be lowered enough that statins are no longer necessary.

The 2017 study you quote has been upended by more-recent studies. A 2019 review of all available trials showed that older adults with known cardiovascular disease (blockages in arteries) had a large benefit in reduction of heart attack, stroke and need for procedures such as bypass surgery.

A 2020 study on veterans with an average age of 81 who did not have heart blockages showed that starting a statin reduced overall death rates by about 25%.

This study was not a clinical trial. It just looked at whether a person’s doctor put them on a statin at an older age.

The higher a person’s risk of heart disease, the more value there is to taking a statin. Recent evidence confirms that this remains true even for people over 75. However, the costs of taking a statin — including the financial cost (much lower than it used to be now many drugs are available as generics), side effects and potential drug interactions — need to be considered.