'Fake news and ageism' keeping statins from older people

Offering statins to all over-75s could prevent 8,000 deaths from heart failure and stroke, researchers say

Thousands of deaths and the wrecking of many lives by disability could be averted if doctors routinely offered a daily statin pill to older people, scientists say.

They blame misinformation about the side-effects of statins, together with society’s ageism, for the low uptake among older people, who are at highest risk of heart attacks, heart failure and stroke.

There are 5.5 million people aged over 75 in the UK, of whom about 1.5 million take a statin. If the rest did so too, about 8,000 additional deaths from cardiovascular events could be prevented, said Prof Colin Baigent, director of the Medical Research Council population health research unit at Oxford University.

More than two-thirds of the 150,000 cardiovascular deaths in the UK each year are in people over 75.

Baigent said there were good reasons why some would not want to take statins, for instance if they had terminal cancer or certain other medical conditions, but the pills were safe and effective and should be offered.

“It is not just about preventing deaths,” he said. “Death is the least of people’s worries when they are elderly. They are more worried about being disabled. Talking to elderly relatives, it is the thing they want to avoid.” He said disability following stroke and heart failure could massively impair people’s quality of life.

Baigent said statins had wrongly become controversial because of misinformation about side-effects. “We have people saying that 20% of those taking a statin get side-effects, which is clear misinformation. It is fake news,” he said. “We have seen, as a result of that, a lot of concern about people being on too much treatment, but it is predicated on the idea that it is doing them harm. That is misinformation.”

The Cholesterol Treatment Trialists’ Collaboration, a project based at Oxford University, has collected data from clinical trials of statins involving 200,000 patients over the last 25 years. Baigent said researchers know what the rare, big hazards of statins are, such as myopathy, which causes muscle weakness. Because of the concerns, they are now examining the data on side-effects and will report probably at the end of the year.

“It is very unlikely that any hazards exist that we don’t already know about,” Baigent said. “The debate about whether statins are associated with particular hazards has got out of control and is blinding us to the clear evidence that we already have.”

People have become muddled by claims of side-effects based not on randomised controlled trials but on observational studies – the reports of patients who know what drug they are taking and assume any pains they feel are down to the pills. “Non-randomised studies are extremely susceptible to bias,” Baigent said. “They are extremely unreliable.”

He said ageism among doctors and society as a whole was also preventing older people from being offered statins. There was an attitude that “a person is elderly, so something is going to happen to them, so why bother?”

The collaboration analysed data from 28 randomised controlled trials involving a total of 186,854 patients, 14,483 of whom were aged over 75. The findings are published in the Lancet medical journal.

Statins reduce the levels of LDL, or “bad” cholesterol, in the blood, measured in millimoles per litre. The study found that for every reduction of 1mmol/L, the risk of a cardiovascular event (heart attack or stroke) dropped by a fifth across all age groups.

The risk reduction was lower in the over 75s than in younger people but still a substantial benefit, the scientists said, because older people are at higher risk.

“Even if risk reduction in people older than 75 years is less than expected, statin therapy may still be justified by a high baseline cardiovascular risk, which is usually present in older people,” writes Bernard Cheung, of the Queen Mary hospital at the University of Hong Kong, in a comment article in the journal.

“The present meta-analysis makes a case to reduce LDL cholesterol in people at risk of cardiovascular events regardless of age, provided that the benefits outweigh the risks and the patient accepts long term treatment.”

Prof Sir Nilesh Samani, medical director at the British Heart Foundation, said: “Concern has been raised about the benefits of statins in older people. This large analysis provides powerful evidence that statins reduce heart attacks and strokes in older people, as they do in younger people, and are safe.

“Age should not be a barrier to prescribing these potentially life-saving drugs to people who are likely to benefit.”

Contributor

Sarah Boseley Health editor

The GuardianTramp

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