May 6, 2015
Statins: Cost-Effective for 75-Plus Cohort but Side Effects Could Limit Use

Corvallis, OR—Should patients older than 75 years take statins to prevent heart attacks and other cardiovascular events?

The therapy is cost-effective, according to a study published recently in Annals of Internal Medicine, but the authors cautioned that potential side effects should be taken into consideration before older patients are prescribed statins.

“Statins look promising as an intervention for this population, but there are concerns about potential physical or cognitive side effects,” said the study’s lead author, Michelle Odden, PhD, an assistant professor of epidemiology in Oregon State University’s College of Public Health and Human Sciences.

“Prior studies have favored statin use because of the clear benefits to the heart and because serious side effects are rare,” added senior author Kirsten Bibbins-Domingo, MD, PhD, a professor of medicine, epidemiology and biostatistics at the University of California San Francisco. “Unfortunately, we don’t have enough studies in older adults, and as a result don’t know enough about how common or how severe the side effects are. Our study showed that in older adults, even small increases in functional limitations and mild cognitive impairments from statin use could result in net harm.”

For the study, researchers used computer modeling to estimate the cost-effectiveness, including risks and benefits, of statin use among older adults. They looked at statins for primary prevention based on a low-density lipoprotein cholesterol threshold of 4.91 mmol/L (190 mg/dL), 4.14 mmol/L (160 mg/dL), or 3.36 mmol/L (130 mg/dL), presence of diabetes, or 10-year risk score of at least 7.5%. The study notes that all adults aged 75 years or older in the National Health and Nutrition Examination Survey have a 10-year risk score that exceeds that percentage.

Treating all adults aged 75 to 94 years would result in 8 million additional users and prevent 105,000 incident myocardial infarctions and 68,000 coronary heart disease deaths at an incremental cost per disability-adjusted life-year of $25,200, according to the study. Treatment is not without potential downsides, however.

“If statins had no effect on functional limitation or cognitive impairment, all primary prevention strategies would prevent MIs and CHD deaths and be cost-effective,” the authors write, pointing out that an increase in the risk of physical or cognitive side effects of 10% to 30% would wipe out the benefits.

The greatest concerns, according to Odden, are muscle weakness and cognitive impairment—both of which have been linked with statins in previous research.

“Physical and cognitive independence are two things that are very important to older adults,” she said. “Both conditions are so impactful that a small increase in risk may not be worth the gains in cardiovascular health.”
U.S. Pharmacist Social Connect