Researchers from HKUMed’s LKS Faculty of Medicine and Harvard’s TH Chan School of Public Health have unveiled the first comprehensive evidence supporting the efficacy of statins in elderly patients, dispelling long-standing uncertainties. This compelling evidence underscores that consistent statin therapy significantly reduces the relative risk of cardiovascular diseases by 21% in individuals aged 75–84 and 35% in those aged 85 and above, with no significant increase in safety concerns.
This groundbreaking study is a significant contribution to the field of geriatric medicine, providing robust, real-world evidence of the benefits of statin usage in older populations through sophisticated analytical techniques. These findings, which have been published in the prestigious ‘Annals of Internal Medicine’, mark a significant step forward in our understanding of cardiovascular disease prevention in the elderly.
Cardiovascular disease remains a primary health concern globally, particularly within ageing populations. Managing high cholesterol effectively is vital for preventing these diseases. Recent data from Hong Kong’s ‘Population Health Survey’ show that 65.6% of people aged 65–84 suffer from high cholesterol. While statins have long been utilised to enhance lipid profiles and mitigate cardiovascular disease risks, there’s been a lack of consensus regarding their use for primary prevention in those over 75. This uncertainty often stems from the inadequate representation of older adults in randomised controlled trials, which leaves significant clinical questions unanswered in everyday healthcare settings. This study leverages real-world data to explore statin therapy’s long-term advantages and potential risks in older adults, aiding in informed decision-making about initiating statin treatment in this expanding demographic.
The study’s research team, led by Professor Eric Wan Yuk-fai from the Department of Family Medicine and Primary Care and the Department of Pharmacology and Pharmacy at HKUMed, analysed public electronic medical records from Hong Kong’s Hospital Authority covering January 2008 to December 2018. This involved over 80,000 older individuals with suboptimal lipid levels and conditions that heightened their risk of cardiovascular diseases, such as diabetes. They employed a novel method known as target trial emulation, which mimics the characteristics of randomised controlled trials within the framework of an observational study, greatly diminishing the typical biases associated with observational research.
The results revealed that continuous statin use correlated with a 21% reduction in relative risk and a 5% absolute risk reduction over five years in cardiovascular diseases among individuals aged 75–84. For those aged 85 and older, the relative risk reduction reached an even more impressive 35%, with an absolute risk reduction of 12.5% over five years. Furthermore, the study identified no significant increase in the risk of major adverse events such as liver dysfunction or myopathies in this demographic.
The study’s findings have global relevance, affirming the safety and efficacy of statins for the primary prevention of cardiovascular diseases in older adults. It indicates that advanced age alone should not preclude high-risk patients from the benefits of statin therapy. With the global burden of cardiovascular diseases in ageing populations on the rise, this research provides crucial evidence supporting the prescription of statins for primary prevention in these vulnerable groups, regardless of geographical location.
Professor Cindy Lam Lo-kuen, from HKUMed’s Department of Family Medicine and Primary Care, highlighted the implications of these findings for clinical decision-making regarding statin therapy initiation in this growing population segment. The study’s innovative approach, particularly the use of target trial emulation, not only paves the way for future research in geriatric medicine but also has the potential to significantly improve healthcare outcomes for older populations globally. This method can produce valuable insights into the care of the elderly, thus enhancing healthcare outcomes for older populations globally.
More information: Wanchun Xu et al, Benefits and Risks Associated With Statin Therapy for Primary Prevention in Old and Very Old Adults: Real-World Evidence From a Target Trial Emulation Study, Annals of Internal Medicine. DOI: 10.7326/M24-0004
Journal information: Annals of Internal Medicine Provided by The University of Hong Kong
