Researchers say the findings support reconsidering the use of these drugs for most people over 70.
A modeling study on the lifetime benefits of statin treatment for individuals over 70, published in the journal Heart, suggests that statins are cost-effective and associated with improved health outcomes in older adults, whether or not they have a history of cardiovascular disease. However, the reduction in risk was notably smaller for those without prior cardiovascular conditions.
The findings back consideration of these drugs for most over-70s, say the researchers.
Statins are used extensively to ward off heart attacks and strokes in middle-aged people, supported by strong evidence from clinical trials. But the evidence to back their use in older adults, especially those without a history of cardiovascular disease, is less definitive, so guidelines stop short of recommending these drugs for this group, explain the researchers.
Underuse of Statins Among Older Adults
But the UK’s aging population means that the over-70s now make up around 30% of people over the age of 40, yet despite cardiovascular risk increasing with age, statin use is lower among the over-70s.
The researchers therefore modelled the lifetime effects and cost-effectiveness of statin therapy for people aged 70 and above using the latest evidence on these drugs’ safety and effectiveness in older people.
They projected cardiovascular risks, survival, quality-adjusted life years (QALYs)—years lived in good health—and healthcare costs of statin use in 5103 people with previous cardiovascular disease and in 15,019 without.
Their calculations indicated that lifetime use of a standard statin (reducing low-density ‘bad’ Cholesterol by 35%-45%) increased QALYs by 0.24–0.70, while higher intensity statin therapy (reduction of 45% or more) increased QALYs by a further 0.04–0.13.
The use of statins was cost-effective with the cost per QALY gained below £3502 for standard therapy and below £11,778 for higher intensity therapy, which is well under the current threshold for good value interventions of about £20,000 per QALY gained, note the researchers.
Cost-Effectiveness and Uncertainty
Statins were still cost-effective after further in-depth analyses, although with a larger degree of uncertainty among older people without previous cardiovascular disease, among whom the reductions in risk were substantially smaller.
This is an observational study, and as such, can’t establish cause and effect. And the researchers acknowledge that most participants were aged between 70 and early 80s, and that the model drew on volunteers which may limit generalisability.
The results of recent clinical trial trials have also indicated a small excess of mild muscle symptoms in the first year of treatment although these were unlikely to materially affect cost-effectiveness.
Nevertheless, the researchers conclude: “This study reports that statin therapy is highly likely to be cost-effective in older people, although there was greater uncertainty among older people without [cardiovascular disease] in scenario analysis, with substantially smaller risk reductions with statin therapy.
“While further randomized evidence will be helpful, the robustness of these findings indicates that [most] older people are likely to benefit cost-effectively from statin therapy and should be considered for treatment.”
Reference: “Lifetime effects and cost-effectiveness of statin therapy for older people in the United Kingdom: a modelling study” by Borislava Mihaylova, Runguo Wu, Junwen Zhou, Claire Williams, Iryna Schlackow, Jonathan Emberson, Christina Reith, Anthony Keech, John Robson, Richard Parnell, Jane Armitage, Alastair Gray, John Simes and Colin Baigent, 10 September 2024, Heart.
DOI: 10.1136/heartjnl-2024-324052
Funding: UK NIHR Health Technology Assessment (HTA) Programme; British Heart Foundation; UK Medical Research Council; National Institute for Health Research Barts Biomedical Research Centre
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5 Comments
I call BS. If your cholesterol is normal and you don’t have heart disease, then why risk the side effects of statins, such as muscle pain that affects 10-15% of users?
I agree with you in general. To be fair, the report does state the benefits achieved by people with no cardiovascular problems are small. I wouldn’t risk it.
People really need to understand how statins work. They block you body from absorbing fats. In turn you cells starve for cholesterol to make fibrous muscle. This is the connecting tissue between the muscle and the bone. While it does lower the cholesterol in the blood and reduces artery damage, the damage it does to muscles may be worse than the benefits. I know this because I am one that suffers from the destruction of muscle fiber by taking statins. There is a much better way to reduce cholesterol. It’s called a 9PCSK blocker. The reason we develop high cholesterol when we get older is that the body starts to make an enzyme called 9PCSK. This enzyme attaches to the receptors in the liver that take cholesterol out of the blood and regulates the level. They have medicine out there that does this, it’s just expensive. They have a pill form in the works but the makers of statins are hauling in the bucks and dont want to invest in making the meds less expensive. The insurance companies dont want to pay for these drugs because they would rather you die and then they can get you off of the liability list. The 9PCSK blocker has NO side effects, I have been taking it for over 10 years now and I now have a cholesterol level of below 140. My diet is not too bad, but I dont have to restrict what I eat at all. We really need to force the drug companies to move forward with this drug despite what insurance companies say! We can rid the world of cholesterol problems forever but it means rich people who own the insurance companies will loose a revenue stream. Read about all of this, I’m not lying.
Correction on this. I said we have a medicine that does the same as the enzyme that blocks receptors. What I meant is that we have a medicine that prevents the 9PCSK form blocking liver receptors and allows the liver to function as it did when it was 20 years old.
Sorry for the misleading mistake.
Well, my doctor had me on statins when I was in my early seventies. I developed muscle weakness in my legs (one of the possible side effects) so I quit taking them. And recovered my usual leg strength. Was on them only a few months. Years later, I developed peripheral neuropathy (don’t know if there was any connection, but …
At age 94 (come next month) still kicking, but cardio problems beginning to surface. If I had it to do over, I would not take the statins.
Recent revelations about the CDC have shaken my faith.