September 10, 2024

expert reaction to modelling study looking at effects and cost-effectiveness of statins in the over-70s in the UK

A study published in Heart looks at looks at the effects and cost effectiveness of statins in over-70s.

Dr Gavin Stewart, Reader in Interdisciplinary Evidence Synthesis, Newcastle University, said:

“The finding that statins are cost effective and linked to better health outcomes in older people is likely to be robust.  It is based on sound analysis and interpretation of well conducted individual patient data meta-analysis and modelling.  Notwithstanding the uncertainty associated with modelling observational data, it appears that statins are likely to improve health in average older people.”

Dr Sonya Babu-Narayan, Associate Medical Director at the British Heart Foundation and a consultant cardiologist, said:

“Statins have transformed prevention of future heart attacks and strokes.  Numerous clinical trials over the last decades have shown strong evidence for their routine use in people at high risk of having a heart attack or stroke, or in those that have had a heart attack already, regardless of age.

“As someone ages, the risk of a heart attack or stroke happening increases, heightened by additional risk factors like high cholesterol, high blood pressure, obesity and diabetes.  This large population study suggests that, for older people, being on a statin was linked to an increase in healthy life years and is cost effective.  That’s important not least because we in the UK have an ageing population who want to live healthier for longer.

“Statins could be an important ‘primary prevention’ for heart attack and stroke, devastating and deadly events which can be disabling for those who survive.  The study is an observational modelling study so cannot determine the causes of the associations seen, and findings in the volunteers may not be representative for all.  Nevertheless, it does show that there may be lifetime benefits for the over 70s at a population level.  For individuals, the decision to take a statin should be based on a discussion between patient and doctor about personal risks and benefits.”

Prof Tim Chico, Professor of Cardiovascular Medicine and Honorary Consultant Cardiologist, University of Sheffield, said:

“The most reliable way to understand whether a treatment like statins prevents heart disease is a randomised controlled trial (RCT) where people are given the drug or placebo.  RCTs are incredibly valuable but very expensive.  RCTs also tend to include fewer older people, fewer women, and fewer people from ethnic minorities.  This means evidence from RCTs may not be as reliable in the types of people.

“Evidence from combining data from multiple RCTs (called a metanalysis) has previously suggested that people over 70 do get a benefit from statins.

“This new study takes an approach to “simulate” what would happen if people over 70 were treated with statins.  The model used for the simulation assumes the benefit of statins shown in the previous metanalysis, so this study is not itself proof of a benefit.  The model does accurately simulate risk of future heart disease in older people, and it suggests that statins provide a cost-effective benefit even in older people.

“Two RCTs are ongoing to understand whether statins are as effective in older people as they are in younger people, but in the meantime the weight of evidence suggests that even people over 70 years can benefit from statins.”

‘Lifetime effects and cost-effectiveness of statin therapy for older people in the United Kingdom: a modelling study’ by Borislava Mihaylova et al. was published in Heart at 23:30 UK time on Tuesday 10 September 2024.

DOI: 10.1136/heartjnl-2024-324052

Declared interests

Dr Gavin Stewart: “No conflicts of interests to declare.”

Dr Sonya Babu-Narayan: “No conflicts of interest.”

Prof Tim Chico: “No conflicts.”