Statins may prevent mortality in older adults with hypercholesterolaemia

Statins appear to be useful as a primary prevention treatment in older adults with hypercholesterolaemia, reports a new meta-analysis.

From the databases of Medline, Embase and the Cochrane Library, researchers retrieved 35 randomized controlled trials eligible for analysis. The main study outcome was all-cause mortality and was assessed using the frequentist and the Bayesian approaches.

Cumulatively, 192,079 patients were included in the study, of whom 18,260 died. Fourteen of the included studies had participants that were only <75 years of age.

Analyses were categorized according to age. There were 14,483 participants who were older than 75 years, with an average age of 78.8±2.8 years. In this subgroup, 3,189 had died. In terms of nonfatal events, 5.8 percent had myocardial infarctions, 2.3 percent underwent percutaneous coronary interventions/coronary artery bypass grafting, and 3.5 percent developed strokes.

Bayesian analysis revealed a risk ratio for death that was less than zero, along with the upper bound of its 95 percent confidence interval. This suggested that elderly adults can derive survival benefits from prevention treatment with statins (p=0.03). No such effect was detected by the frequentist analysis.

“Current guidelines for the management for hypercholesterolaemia both in the US and Europe do not recommend statins for older people for primary prevention,” the researchers said. “The primary reason for this lack of recommendation to treat was that there were no sufficient clinical trial data to recommend treatment in this population subset.”

The frequentist analysis supports this treatment protocol, while the Bayesian approach does not. Further studies are required to address this.