Lipid lowering drugs in the elderly may decrease stroke risk

1. Elderly patients with no history of vascular events who took statins or fibrates for primary prevention experienced an over 30% reduction in the risk of stroke.

2. No similar association was found between lipid lowering drug use and coronary heart disease.

Evidence Rating Level: 1 (Excellent)      

Study Rundown: Abundant studies exist that demonstrate the benefit of statins for people with a history of cardiovascular disease. Specifically, people experience a reduction in major cardiovascular and cerebrovascular events such as heart attacks and strokes. However, whether statins have any benefit in the primary prevention of these events, specifically in the elderly who are most at risk, is unknown. The purpose of this study was to determine the effectiveness of lipid lowering drugs, such as statins and fibrates, on the incidence of coronary heart disease and strokes when used as primary prevention in nearly 7,500 elderly French residents (>65 years) who had no history of vascular events. Compared to non-users of the medications, lipid lowering drug users were in fact at an over 30% decreased risk of stroke over an average of 9 years. A similar effect was not observed for coronary heart disease.

This study benefited from being able to prospectively collect data on a large population of French residents. Additionally, vascular events were validated; for example, stroke events were confirmed with brain imaging and so the results are more reliable. However, the results may not be generalizable to the entire French population or the United States because the participants in the three cities where the study took place were generally more educated and had higher economic statuses. They also led relatively healthy lifestyles, which could have reduced their risk of cardiovascular events in the study. Overall, the study suggests that elderly people with no prior history of vascular events can benefit from statins or fibrates as a means of decreasing their risk of stroke.

Click to read the study, published today in the BMJ

Click to read an accompanying editorial in the BMJ

Relevant Reading: Cardiovascular drug therapy in the elderly: benefits and challenges

In-Depth [prospective cohort]: This study looked to determine whether any benefit existed for elderly people with no prior vascular history to take statins or fibrates as primary prevention against cardiovascular or cerebrovascular events. In particular, they looked at 7,484 men and women with a mean age 73.9 years in 3 different French cities between 1999-2001. With an average 9.1 year follow-up period, the authors conducted face-to-face examinations every two years and gathered a great deal of demographic and medical information. Specifically, 2,048 people used either statins (13.5%) or fibrates (13.8%). The risk of stroke was reduced by 34% in people on these medications (HR 0.66, CI_95% 0.49-0.90) compared to non-users. This reduced risk was similar with both statins and fibrates. In contrast, the risk of coronary heart disease was no lower for lipid lowering drug users (HR 1.12, CI_95% 0.90-1.40). Analyses were then stratified by a number of variables, including age, body mass index, history of hypertension and triglyceride levels, and no effect modification was observed.

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