December 3, 2014
Statin Therapy: Good for Nearly Everyone in Late 60s,Minneapolis, MN—All men in their late 60s and early 70s—and the vast majority of women—likely should be on a statin, according to a recently published research letter.
The letter, appearing in JAMA Internal Medicine, said that recommendation is based on the newest cholesterol guidelines from the American College of Cardiology (ACC) and the American Heart Association (AHA). Those guidelines, out for about a year, target individuals who are most likely to benefit from cholesterol-lowering therapy.
“The guidelines are a significant change from prior guidelines that relied heavily on levels of bad cholesterol to determine who to treat,” said Michael D. Miedema, MD, MPH, a research cardiologist at Minneapolis Heart Institute Foundation and cardiologist at Minneapolis Heart Institute at Abbott Northwestern Hospital. “Instead, the new guidelines recommend focusing statin therapy on the individuals that are at the highest risk for heart attack and stroke, even if their cholesterol levels are within normal limits.”
The guidelines don’t just recommend statin therapy for patients with known cardiovascular disease, diabetes, or significantly elevated cholesterol levels. They also urge the use of a risk calculator—using age, gender, race, and other factors—to determine risk of heart attack or stroke in the next decade. Patients with an estimated 10-year risk higher than 7.5% are urged to consider statin therapy.
“Older individuals will likely cross the 7.5% threshold based on age alone, even if they have normal cholesterol levels and no other cardiovascular risk factors, and our study confirms this notion,” Miedema pointed out.
For the research letter, Miedema and his colleagues looked at 6,088 black and white adults between the ages of 66 and 90 in the Atherosclerosis Risk in Communities (ARIC) Study, an approximately 25-year longitudinal study of cardiovascular disease sponsored by the National Heart, Lung, and Blood Institute. When the ARIC cohort was reassessed in 2013, the study analyzed the volume of statin-eligible participants, comparing the previous Adult Treatment Panel (ATP) III cholesterol guidelines to the newer ACC/AHA guidelines.
“Based on the ATP III guidelines, we found that just over 70% of the ARIC participants were eligible for statin therapy,” Miedema said. “In contrast, 97% were statin eligible by ACC/AHA criteria. For men 66-75 years old, the qualification rate was 100%.”
Half of the cohort was older than 75, at which point ACC/AHA guidelines make no recommendations about cholesterol-lowering therapy. Yet, according to researchers, more than half of participants in that age cohort were taking statins.
“We don't have great data on the efficacy of statin medications in the elderly so the guidelines drew a cut-off for the recommendations at age 75,” Miedema said. “This is understandable, but it kind of leaves clinicians in the dark as to what to do with healthy elderly patients, who are often at high risk for heart attacks and strokes.
“We clearly need more research looking at the best way to determine who should and should not take a statin, as well as the risks and benefits of statin therapy in elderly patients.”
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