Too Many Older People Take Statins

In the last couple of years, the class of medications known as statins has gotten a lot of attention, most recently this month when NPR reported concern over the popularity of prescribing statins for the elderly.

Statins are cholesterol-lowering drugs with “statin” somewhere in the generic name; brand names include Crestor, Lipitor and Zocor. People with elevated blood cholesterol levels are at greater risk for heart disease  and stroke.

The NPR story said that a lot of doctors prescribe them almost as a default treatment, a better-safe-than-sorry way to prevent heart trouble in their very elderly patients. That’s problematic, because there’s a lack of science to show the wisdom of such a broad-brush approach for this age group.

A few years ago, the American Journal of Cardiology noted that there’s little research among people older than 79 showing that statins’ preventive heart benefits outweigh the possible risks, including muscle pain and diabetes. A more recent study in JAMA showed that seniors with no history of heart trouble are about four times likelier to be prescribed those drugs than they were in 1999.

The authors of that study wrote that “the very elderly have the highest rate of statin use in the United States.”

The American Heart Association and the American College of Cardiology issued guidelines a couple of years ago for using statins as a preventive measure for people with high cholesterol but no diagnosed heart disease if their 10-year risk of suffering a heart attack or stroke is 7.5% or higher.

Some scientists have questioned the risk calculator developed in concert with that guideline because they believe it might overestimate risk.

And the calculator applies only to patients younger than 75 precisely because of the lack of clinical trial data for the very elderly. So doctors have to decide whether statins as preventive medicine is good for the elderly given the potential harms and the patient’s life expectancy. And they seem to be tilting toward overuse.

Lots of luminaries in the medical community are concerned about the general overuse of statins, including Dr. Harlan Krumholz (see our blog, “A Wise Man Analyzes the Renewed Attention on Statins.”)

Referring to the Heart Association guidelines, last month, cardiologists at Johns Hopkins and the Mayo Clinic concluded that “overreliance on such algorithms can lead to unnecessary treatment with statins,” and called for updates to heart disease prevention guidelines.

Statins often are a good idea to reduce the risks of a heart attack or stroke for people who have suffered those conditions, and maybe to prevent an episode for people who have high cholesterol. But, as NPR pointed out, even though the average life expectancy in the U.S. is 76 for men and 81 for women, drug company research, including statin research, focuses on younger people.

Dr. Steven Nissen, department chair of cardiovascular medicine at the Cleveland Clinic, wants Congress to legislate incentives for drug manufacturers to conduct research into the effects on the elderly of a wide array of drugs, because statins aren’t the only meds in which that demographic has been underrepresented in clinical trials.

Dr. Michael Johansen, one of the authors of the recent statins study, told NPR that he hoped doctors would be more cautious about which elderly patients take them for prevention. Muscle pains that some seniors experience while taking the drugs might cause them to fall, he noted to NPR, and that could cause other life-threatening injuries.

“We just don’t know,” he said.

Learn more about statins in Patrick’s newsletter, “Should a Statin Drug Be in Your Medicine Cabinet?”

 

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