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Efficacy and Safety of Statin Monotherapy in Older Adults: A Meta-Analysis

¹ Division of Endocrinology, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
² Department of Epidemiology, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland.

Address correspondence to Annabelle Rodriguez, MD, Johns Hopkins Bayview Medical Center, 5200 Eastern Avenue, Mason F. Lord, Center Tower, Suite 4300, Baltimore, MD 21224. E-mail: arodrig5{at}jhmi.edu

Background. Statin therapy significantly reduces cardiovascular events. Older patients, however, are less likely to be prescribed statins than younger patients due to concern over lack of indication, lower predictive value of cholesterol levels, and increased risk of adverse events. To determine the effect of statins on all-cause mortality and on major cardiovascular events, including stroke, we performed a meta-analysis of statin trials that included older adult participants.

Methods. Mortality, cardiovascular events, and adverse event outcomes were extracted from published randomized, placebo-controlled clinical trials of persons aged 60 years and older.

Results. Data on 51,351 patients were evaluated. Statins reduced all-cause mortality by 15% (95% confidence interval, 7%–22%), coronary heart disease (CHD) death by 23% (15%–29%), fatal or nonfatal myocardial infarction (MI) by 26% (22%–30%), and fatal or nonfatal stroke by 24% (10%–35%). The relative risk of cancer comparing statins to placebo was 1.06 (0.95–1.18). Adverse event data were not consistently reported.

Conclusions. Statin therapy significantly reduced all-cause and CHD mortality, as well as risk of stroke and MI. Statin therapy should be offered to older patients at high risk of atherosclerotic disease events.