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EBM Verdict
Primary care
Absolute effects of statins in the elderly
  1. Carl Heneghan,
  2. Kamal R Mahtani
  1. Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
  1. Correspondence to Professor Carl Heneghan, Primary Care Health Sciences, University of Oxford, Oxford OX1 2JD, UK; carl.heneghan{at}phc.ox.ac.uk

https://doi.org/10.1136/bmjebm-2019-111189

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    The effects of statins in the elderly are better informed by absolute effects and the number needed to evaluate the benefit to harm balance. Such an approach enables patients to make more informative choices.

    Statins have proved to be a controversial topic. Thirty years after their approval, uncertainties remain about the benefit to harm balance in primary prevention of cardiovascular events, particularly in low-risk individuals and in the elderly. A recent meta-analysis of 28 trials including 14 483 (8%) participants older than 75 years aimed to reduce the uncertainties in statins in this older age group.1

    After an average of 4.9 years of follow-up outcomes reported include major coronary events (non-fatal myocardial infarction or coronary death), coronary revascularisation (angioplasty or bypass grafting), stroke (subdivided by type), site-specific cancers and cause-specific mortality. Major vascular events were defined post hoc as a composite of major coronary events, coronary revascularisation and stroke.

    The study concluded: ‘Statin therapy produces significant reductions in major vascular events irrespective of age, but there is less direct evidence of benefit among …

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    Footnotes

    • Contributors CH wrote the first draft and KRM approved the final draft.

    • Competing interests CH and KRM are supported by the NIHR School for Primary Care Research Evidence Synthesis Working group (NIHR SPCR ESWG project 390). CH is also supported by the NIHR Oxford Biomedical Research Centre, is NIHR Senior Investigator and Editor-in-Chief of BMJ Evidence-Based Medicine. KRM is Associate Editor of BMJ EBM.

    • Provenance and peer review Commissioned; internally peer reviewed.