“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.
The authors of that study followed 5,800 patients for three years and found that pravastatin provided secondary, but not primary, prevention against cardiovascular events.
But Dr. Paul Ridker, a self-described “statin advocate” who directs the Center for Cardiovascular Disease Prevention at Brigham and Women’s Hospital in Boston, gets irked at the argument that we don’t know enough to give statins to older patients without heart disease.
“I don’t believe there’s any doubt that statin therapy is effective for primary prevention in older adults,” Dr. Ridker said. He cites a recent reanalysis of data from two major studies showing that patients over age 70 taking statins experienced the same reductions in cardiovascular…