Lower Doses of Statins Just as Effective in Older Adults Who Are at Greater Risk of Side Effects from the Cholesterol Drugs

When adults are found to have high levels LDL—the form of cholesterol that can raise the risk of stroke and heart attack—their clinicians typically start them on a high dose of statin, the widely used medications that lower cholesterol levels in the blood.

But when statin users 75 years and older take those higher levels, there can be negative side effects that decrease their quality of life, such as muscle and joint pains, and a higher risk of developing diabetes.

Now, new research finds that starting cholesterol lowering treatment with a low- to moderate-intensity statin was associated with a greater reduction of LDL levels among older patients than with younger ones. It’s an important finding because older adults—underrepresented in clinical trials of statins—have more frequent side effects from taking statins.

“This research shows that a lower intensity statin may be just as effective in reducing LDL cholesterol levels in older patients as a higher dose is in younger patients,” said Stanford Health Policy’s Mark Hlatky, MD, a professor of health policy and cardiovascular medicine at Stanford Medicine. “Since older patients are more susceptible to adverse effects—and adverse effects are more likely at higher doses—starting at a lower intensity in older patients will likely be better tolerated.”

Hlatky is a co-author of the original research published in Annals of Internal Medicine. The senior author is Marie Lund, MD, PhD, researcher at Statens Serum Institut and Clinical Associate Professor at University of Copenhagen.

Danish Nationwide Cohort

The researchers used a nationwide Danish cohort of nearly 83,000 adults from 2008 to 2018.

“By using the unique Danish nationwide registries, we were able to study more than 80,000 people who initiated statin therapy in routine clinical practice, and we were able to address the association between age and reduction of LDL cholesterol with an unprecedented level of detail,” Hlatky said.

The study found that among 82,958 first-time statin users, 13% were aged 75 years or older and had greater mean LDL reductions than younger initiators of statins. For example, 39.0% vs. 33.8% for 20 mg of simvastatin, and 44.2% vs. 40.2% for 20 mg of atorvastatin.

The researchers noted older patients having a greater LDL response to lower-intensity statins does not necessarily mean they’ll get a greater risk reduction for cardiovascular disease from taking a statin.

“The LDL cholesterol response is an important intermediate outcome measure that has been associated with the degree of risk reduction in large, randomized trials of statins,” Hlatky said. “Our study, however, did not assess the effect of statin dose on hard outcomes, like cardiovascular death or myocardial infarction, so we can’t directly assess any effects on CVD risk.”

The authors also emphasized that large studies about the effects of statins in primary prevention of cardiovascular disease among adults 75 and older are needed, and are being investigated in ongoing randomized trials, such as the PREVENTABLE and STAREE.