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Statin and stoppin’: study unpacks drug concerns

Statins seem to make headlines across Australia every year – some touting their benefits and safety, others warning of side effects.

No example of the power of media coverage on the class of cholesterol-lowering drugs is as pertinent as that of ABC TV’s Catalyst program. The 2013 report questioned the effectiveness of statins and, according to one study, led more than 60,000 Australians to cut back or stop taking the drugs.

Health organisations rallied to ease some concerns. And they continue to do so as headlines about safety and risks versus effectiveness continue, particularly in relation to older adults.

Now, Australian and international researchers have released a study that holds statin therapy is both effective and safe for people aged over 75 years.

Published in The Lancet, the study summarised all available evidence from major trials to help clarify the issue.

It revealed significant reductions in major vascular events in each of the six age groups considered, ranging from under 55 years to over 75 years.

The study also found that statin therapy did not increase the risk of deaths from non-cardiovascular disease, or the risk of cancer, at any age.

Co-investigator Dr Jordan Fulcher from the University of Sydney said statin therapy appears to be just as effective in people aged over 75 years as it is in younger people. “We now have definitive evidence that statins benefit older people who have suffered a heart attack or stroke.”

The picture of cardiovascular risk reduction was less clear among people aged over 75 without pre-existing vascular disease. But the team said a new trial is studying the effects of statins in more depth in healthy older people.

“More information in this group of people would help confirm the same benefits that we see in our overall trials population,” Fulcher said.

In a linked editorial, Bernard Cheung and Karen Lam from the University of Hong Kong, reminded readers that no drug is completely harmless.

They wrote:

When statins are used in people with low cardiovascular risk, the risks and benefits need to be weighed against each other. Statins have been associated with a slight increase in incidence of muscle pain, diabetes, and haemorrhagic stroke, but their benefits in prevention of major vascular events are shown to be much greater. The present meta-analysis that includes people older than standard trial populations echoes this conclusion.

The challenge for the healthcare profession and the media is to convey risks and benefits in ways that patients can understand, enabling them to make an informed choice.”

Still, Fulcher said that this new study will “provide reassurance and guidance for doctors and patients alike that people are not automatically ‘too old’ for treatments like statins to be effective”.

Fellow researcher Professor Colin Baigent, from the University of Oxford, said while the risk of heart attacks and strokes increases markedly with age, statins are not used as widely in older people as they should be.

“Since the risk of heart attack and stroke increases with age, the potential benefits are likely to be even greater for older people.

“Therefore, there is a need to ensure that patients at risk of cardiovascular disease due to their age are offered statin therapy where there is good reason to believe that it will be beneficial. Anyone with concerns about whether statin therapy is suitable for them should discuss this with their GP.”

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