For some people, the use of statins continues to be a concern. Concern, not because they don’t do what they’re supposed to, but because of their associated adverse effects. Medical journals recently have had numerous articles about the use of statins in people over age 75. Are they safe enough to take? Are they really helpful?
There’s no denying that statins lower LDL-C, the bad cholesterol, and have a profound effect on reducing heart attack, stroke, and cardiovascular deaths. But these benefits occur mainly in people 40-75 years old. For “healthy” older adults it’s different.
“No study has shown an impact of statins on cardiovascular outcomes among older adults without pre-existing coronary artery disease (CAD) or significant risk factors (diabetes, strong family history).” So if you’re over 75, have not had a stroke or heart attack, and are not diabetic, statins are not recommended. Still, many such patients have been prescribed statins “despite potential adverse effects and no evidence of effectiveness.”
For patients who have a history of CAD, heart attack, or stroke, statins have clearly been shown to be of benefit in preventing recurrent CV events. But there has been no overall reduction in mortality. Well, of course not. Everyone eventually dies of something. Did these statin folks live longer and have a better quality of life free of cardiovascular disease? That information is not forthcoming.
Foremost among those “adverse effects” is muscle pain. Anywhere from 1-5% of patients on statins will have muscle pain. That doesn’t sound like very much, but when you add associated “muscle weakness and fatigue,” and an increased risk of “falls and fractures in patients older than 80 years,” it is. So the numbers are small, but the condition is problematic enough to be a concern.
In September 2019, I wrote a blog about statins in the elderly. In that article, I “opined” that statins should be in the water and should be taken, regardless of age, for the prevention of cardiovascular disease as long as the patient was not experiencing bothersome side effects. I still feel that way. Every adult has hardening of the arteries to some degree. It’s just a part of aging. Some have it worse than others and experience cardiovascular events (heart attack, stroke, eg.); others do not. But it doesn’t mean their arteries are clean as a whistle. They probably aren’t.
Taking a low- or moderate-potency statin 3 or 4 times a week not only minimizes the chance of side effects, but it provides some of the benefits of statins for preventing cardiovascular events. If the elderly patient is seeing his doctor regularly, is being closely monitored for muscle pain and weakness, is being evaluated for fall risk, and has quarterly blood tests for liver and muscle enzymes, I think a statin is still advisable, in spite of the United States Preventive Services Task Force (USPSTF) recommendations against it.
References: Lazris A, Roth AR. Over Use of Statins in Older Adults. JAMA 2019 Dec 15;100(12):742-743.
Gilkison WM. If You’re Old Should You Take a Statin? Dr. G opines.com 2019 Sep15.
