Among older adults, statin use tied to decreased risk of early death

"Based on these data, age is not a reason to not prescribe statins," said lead and corresponding author Ariela Orkaby, MD, MPH, a physician scientist at VA Boston Health Care System and in the Division of Aging at the Brigham . "Statins are commonly studied and prescribed for middle-aged adults but understudied in people over age 75. One of the most remarkable things about our results is that we found the benefit of statins held true regardless of whether a person was older or younger or had a condition such as dementia."

Orkaby and colleagues looked at data on veterans who used VA services between 2002 and 2012, were 75 years or older, and had not previously had a heart attack, stroke or other cardiovascular event. Of the more than 300,000 eligible veterans, the team identified more than 57,000 who began taking statins during this time. Using propensity scoring, the authors compared individuals who began taking statins to those who had the same likelihood of being prescribed a statin based on clinical characteristics but did not receive a prescription for the drug.

Overall, taking statins was significantly associated with lower risk of death from a cardiovascular event or death from any cause. And the benefits remained for veterans at advanced age, including those who were 90 years or older. Lower death rates extended to those with other conditions such as dementia -- individuals who have been excluded from previous studies. In secondary analyses, the team found that starting a statin was also significantly associated with a lower risk of cardiovascular events such as heart attacks and strokes. Orkaby notes that it was particularly intriguing to see a marked decline in rate of strokes among the study's black participants.

"There are many interesting leads to follow up on," said Orkaby, "but it's important to keep in mind that this is not a randomized, clinical trial. Instead, it's a retrospective analysis using real world data that helps us explore where the truth lies."

The study focused only on veterans, a predominantly white and male population, which may limit its generalizability, but the study's size made it possible to glean statistically meaningful information on underrepresented groups. During the study's timeframe, the most commonly prescribed statin was simvastatin, but currently, higher-dose and higher-intensity statins have become more frequently prescribed. While statins are generally well tolerated, many people report aches and pains as a side effect, which may lead some to stop taking the drug. The current study did not evaluate whether patients discontinued statin use.

Two randomized, clinical trials of statins among older adults are now underway with results from one of the studies expected later this year. Orkaby and colleagues plan to follow up on their study by exploring the effects of statin dosing and examining outcomes for sub-populations included in their analysis.