The ALLHAT-LLT randomized clinical trial found no benefit of statin treatment in adults over 65 with moderate hyperlipidemia and hypertension.
The leading cause of morbidity and mortality in the US is cardiovascular disease. Statins reduce the risk of morbidity and mortality by affecting lipids. Studies have shown that statin therapy in adults at increased cardiovascular risk, but without prior cardiovascular events, reduced the risk of clinical outcomes versus a placebo. Demographic and clinical characteristics notwithstanding, the outcomes associated with statin therapy were similar for patient subgroups. However, there are only a few trials that enrolled patients older than 75 years.
Statins affected all patients irrespective of their elevated lipid and baseline levels. In the JUPITER trial, the number needed to treat to prevent 1 cardiovascular event was 94 in people younger than 70 years and 62 in those 70 years and older.
In order to determine if statin treatment among adults aged 65 to 74 years and over 75 years affected all-cause mortality, cause-specific mortality and non-fatal myocardial infarction or fatal coronary heart disease combined, a group led by Benjamin Han at the New York University School of Medicine and collaborators tested these objectives in the Lipid-Lowering Trial (LLT) component of the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT-LLT).
Among the 10 355 participants in the ALLHAT-LLT trial, 1467 participants in the pravastatin group and 1400 participants in the usual care (UC) group formed the study population. The results of the analysis showed that pravastatin did not have any benefit in all-cause mortality, cause-specific mortality and non-fatal myocardial infarction or fatal coronary heart disease combined. Among participants in the pravastatin group who were 65 to 74 years old, there were 141 deaths compared to 130 deaths in the UC group.
The authors conclude that statins may have pronounced untoward effects in the health of older adults that minimize possible benefits to cardiovascular health. Although the study included a large population of high-risk older adults, the limitations are that this is a post hoc secondary analysis of a subgroup of participants in the ALLHAT-LLT and the exclusion criterion of current use of lipid lowering therapy at baseline. This study should serve as a guideline for the use of statins for primary prevention in adults 75 years and older.
Written By: Joseph M. Antony, PhD