Since many readers of Dr. G Opines have reached the ripe old age of 75, the results of the article referenced in this blog post have real significance. A lot of doctors who claim expertise in the use and value of statin therapy have recommended against their use in folks over 75. That’s true! They must think life ends at 75, otherwise, why tell 75 year olds they no longer need a statin. Are people over 75 suddenly dispensable? They “represent one of the fastest-growing population subgroups in the health care system.” Isn’t it true the older you get, the more likely you are to have Arteriosclerotic Cardiovascular Disease (ASCVD)?
An article in JAMA showed that prescribing statins to those people 75 years and older was “significantly associated with a lower risk of all-cause and cardiovascular mortality.” It very emphatically encourages the use of statins not only in the 40-75 year age group, but to older folks as well. I couldn’t agree more! Remember, I’m the guy who said “statins should be in the water.”
The recommendation evolved from a huge study done on Veteran’s Administration patients. Veterans are a captive audience so 326,981 of them not previously known to have ASCVD were started on a statin to see if benefits outweighed adverse effects. Their mean age was 81, 97% were male, and 91% were Caucasian so this was not a diverse patient population. Included, though, were many patients with “competing comorbidities such as cancer, mental illness, and dementia.” They were followed for 7 years.
During the study period, 206,902 patients died of all causes. 53,296 died from cardiovascular causes. Deaths in statin users and statin non-users were compared. The results are listed below.
Death from any cause:
Statin users: 78.7 deaths/1000 patients
Statin non-users: 98.2 deaths/1000 patients
Death from ASCVD:
Statin users: 22.6 deaths/1000 patients
Statin non-users: 25.7 deaths/1000 patients
Cardiovascular Events w/o Death:
Statin users: 66.3 events/1000 patients
Statin non-users: 70.4 events/1000 patients
One can clearly see that those who took statins had fewer cardiovascular events, fewer cardiac-related deaths, and, especially, a lot fewer deaths from any cause.
So, to those of you almost-octagenerians, look for that old bottle of Lipitor or Zocor, and start taking it again. But before you do, ask your doctor his opinion and get his OK! If he says you don’t need a statin, you now have something you can show him to justify your request. If he still tells you it’s not necessary, tell him you know a doctor who thinks statins should be in the water, and you’re convinced it will help you to have a better quality of life. Adverse effects from statins were not addressed in this study, but if he brings it up, tell him that’s an issue you’re not concerned about, and you’ve got it covered.
Dr. G’s Opinion: This blog is really of more interest to physicians, but it has practical implications for the older general public, especially older men. By taking a statin drug, deaths from any cause, and particularly cardiovascular disease, are reduced in male veterans age 75 and older. There’s no doubt in my mind there is benefit in taking statins regardless of age. So if you haven’t been taking one and you have no medical reason not to, call your doctor and ask him to phone in a prescription. I think you will be better off for it.
Reference: Orkaby AR, et al. Association of statin use with all-cause and cardiovascular mortality in US veterans 75 years and older. JAMA 2020 July 7;324(1):68-78.
Nichols SJ, Nelson AJ. Statins for Primary Prevention in the Elderly. JAMA 2020July 7:324(1):45-46.
