CORVALLIS, Ore. – Statins could be a cost-effective tool for preventing heart attacks and other cardiovascular incidents in adults over age 75, but the benefits would need to be weighed against potential side effects, a study being published this week in the Annals of Internal Medicine has found.
“Statins look promising as an intervention for this population, but there are concerns about potential physical or cognitive side effects,” said the study’s lead author, Michelle Odden, an assistant professor of epidemiology in OSU's College of Public Health and Human Sciences.
“It’s not all good or all bad; we’re in a gray area,” said Odden, who is affiliated with OSU’s Center for Healthy Aging Research. “That’s where patient preference becomes important. People who are concerned about the side effects should have a conversation with their health care provider.”
Researchers examined whether statins should be routinely given to older adults who are not already taking them as prevention against heart attack, stroke or other cardiovascular events that can affect quality of life and drive up health care costs.
They used computer modeling to estimate the cost-effectiveness, including risks and benefits, of statin use among older adults. The findings indicated that statin use can help prevent cardiovascular incidents, but if that use increased the risk of physical or cognitive side effects by roughly 10 to 30 percent, any benefit from statins would be offset.
“We don’t know what the true risk is,” Odden said. “But we know statin use is very sensitive to these other risks in older populations.”
Statins are a class of drugs used to lower cholesterol and prevent cardiovascular disease caused by high cholesterol. Many types of statins are available in generic form, which keeps drug costs low. Use of such drugs to prevent a significant cardiac event could reduce overall health care costs and improve the quality of life of older adults, Odden said.
More than 40 percent of adults over age 75 already are taking statins. However, medical guidelines for statin use are only for people who start taking statins when they are younger, up to age 75. The drugs are typically prescribed to people who have a history of cardiovascular disease, high cholesterol, diabetes or a high probability of a cardiovascular event within 10 years.
As people live longer and healthier lives, cardiovascular health prevention efforts may need to be adjusted to reflect differences that come with age. Statins seem like a promising option to prevent cardiovascular incidents among older adults, but they may not be beneficial if they introduce side effects such as muscle weakness and cognitive impairment, which are suggested to occur with statin use, Odden said.
“Physical and cognitive independence are two things that are very important to older adults,” she said. “Both conditions are so impactful that a small increase in risk may not be worth the gains in cardiovascular health.”
Additional research, including clinical trials using older adults, would be needed to better understand the benefits and risks of statin use in this population, Odden said.
Co-authors of the study are Mark J. Pletcher, Pamela G. Coxson, David Guzman, David Heller, and Kirsten Bibbins-Domingo of the University of California, San Francisco; Lee Goldman of Columbia University; and Divya Thekkethala of OSU. The research was supported by a grant from the American Heart Association Western States Affiliate and the National Institutes of Health.