Super Statins Benefits Extend to Young and Old Alike

Volume 10, Issue 3

Statins have been the mainstay of cardiovascular disease prevention, both primary and secondary. Historically, statins have been prescribed to patients 40-75 years of age, given this is the group in which they have been most widely studied. However, recent evidence suggests that the benefits of statin therapy may be ageless. In this week’s issue of Talking Therapeutics, we explore new data looking at the benefits of statin therapy for younger and older patients alike.

Point 1: Don’t Deny Older Adults Their Statins

The benefits of statin therapy for those over 75 years of age have not been conclusively established, so some clinicians may consider discontinuing these medications as part of a deprescribing strategy to combat polypharmacy.

This strategy was recently tested in a Danish study of 67,418 adults aged ≥75 years. Of these patients, 27,463 participants were included in the primary prevention cohort (median age, 79 years [IQR, 77-83 years]) and 38,955 participants were in the secondary prevention cohort (median age, 80 years [IQR, 77-84 years]).

The discontinuation rate over the study period was 30% (89,311 of 27,463 participants) in the primary prevention cohort and 25% (9,853 of 39,955 participants) in the secondary prevention cohort. In the primary prevention cohort, the weighted rate difference was 9 per 1,000 person-years (95% confidence interval [CI], 5-12 per 1,000 person-years), corresponding to one excess major adverse cardiac event (MACE) per 112 persons who discontinued statins per year. In the secondary prevention cohort, the weighted rate difference was 13 per 1,000 person-years (95% CI, 8-17 per 1,000 person-years), corresponding to one excess MACE per 77 persons who discontinued statins per year.

While this study lacks the robustness of a randomized analysis, it suggests that among older adults, discontinuation of statins was associated with a higher rate of MACE in both the primary and secondary prevention cohorts.

Point 2: Consider Statins in Young Adults as Well

Statins are currently not recommended in adults younger than 40 years of age unless the patient is at an extremely high risk of MACE. However, approximately 27% of young adults without cardiovascular disease have low-density lipoprotein cholesterol (LDL-C) of ≥130 mg/dL, and 9% of young adults have LDL-C of ≥160 mg/dL. Further, evidence continues to mount suggesting that cumulative exposure to high LDL-C in young adulthood can increase risk of MACE later in life.

Earlier this year, a cost-effectiveness analysis was performed using the US National Health and Nutrition Examination Survey. The model projected that young adult lipid lowering with statins or lifestyle interventions would prevent lifetime cardiovascular disease events and increase quality-adjusted life-years (QALYs) compared with standard care.

Incremental cost-effectiveness ratios (ICERs) were $31,000/QALY for statins in young adult men with LDL-C of ≥130 mg/dL, and $106,000/QALY for statins in young adult women with LDL-C of ≥130 mg/dL. These data suggest that statin treatment for LDL-C of ≥130 mg/dL is highly cost-effective in young adult men and intermediately cost-effective in young adult women.

Interestingly, intensive lifestyle intervention was more costly and less effective than statin therapy.