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

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. THE risk of coronary heart disease (CHD) increasesprogressively with greater total cholesterol levels (1), but the predictive value of cholesterol levels in older individuals is less robust than in younger individuals (2)