Benefits To Treating Cholesterol In The Old And Very Old

You will see a lot of misinformation published by medfluencers truing to convince you that there is no benefit to taking statins if you are above a certain age. They tried so hard to find a study that didn't show benefit, and they couldn't find one. Every single statin trial showed benefit regardless of age or any other factor. So they decided to make up their own study. This is typically what these online grifters do. When they can't find proof, they just make it up.

They could not find studies, so they made up their own study. They published their own meta analysis and excluded studies that had mortality data in them. They also excluded any studies that disproved their point. They were finally able to torture the data enough to publish a study that showed that perhaps a person over the age of 60 might not benefit from statins. Although, this is not what the data actually shows, as we will see below. They just made it up by bending the data and cherry picking enough studies.

The reason they did this is so that they can all publish contrarian books. Nine of the authors on this one paper all had "cholesterol doesn't matter and statins are evil" books to sell. They did not disclose their conflicts of interest. they went on to cite their own research in their books. This is intellectually dishonesty at it's finest.

On such book is The Cholesterol Myth book. The Cholesterol Myth book concluded that treating the elderly with statin therapy had no benefit. They argued that people over the age of 60 should not attempt to lower their cholesterol. This flies in the face of every study we have discussed, as they all had participants over the age of 60 and they all benefited.

But let’s examine a study that looked at those aged 50 to 75.

Graphical summary of this article to share:

Statins Reduce Risk In Those Age 50 To 75

“Evaluation of Time to Benefit of Statins for the Primary Prevention of Cardiovascular Events in Adults Aged 50 to 75 Years”

The study found that adults 50 to 75 years of age have significant benefit from statin use for primary prevention. The exact opposite of what The Cholesterol Myth book concluded. It’s just not as sexy and no one is making up studies to sell you a book.

They found that for every 100 adults you treat with a statin for 2.5 years, you prevent 1 MACE event (major adverse cardiovascular event, like heart attack or stroke). That means the NNT (number needed to treat) was 100. Pretty low by today's standards. Most medications and interventions are approved with NNTs in the thousands.

https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2773065

Statins In those Over 65 Reduced Risk Of Heart Attacks And Strokes 

Another review looked at studies that included older adults to see if lipid lowering therapy made a difference or reduced risk. They found that lipid lowering therapy in those greater than age 65 showed tremendous risk reductions.

The results demonstrated that lipid lowering therapy conferred a 44% relative risk reduction in some trials, but the combined total relative risk reduction was a 25% relative risk reduction. You’ll notice that the lower the achieved LDL-C in the listed studies, the better the risk reduction. See supplemental guide.

From:
https://www.jacc.org/doi/10.1016/j.jacc.2023.08.005

Another study from October 2023 in the Journal of the American College of Cardiology also demonstrated significant reductions in risk regardless of age.

The study demonstrated significant reduction across all age groups. In fact, those who were over 85 years old had lower relative risk than those in the 75-79 age category and those in the 80-84 age category.

For each 1 mmol/L (38.6 mg/dL) reduction in LDL-C you had a 23% reduction in MACE in the elderly and for those who were younger.

From:
https://www.jacc.org/doi/full/10.1016/j.jacc.2023.07.027

Is it ever too late to start statin or lipid lowering therapy?

No.

If your LDL-C was 135 mg/dL and you were to start on lipid lowering therapy at age 60, you would have a 27% reduction in MACE. If you were to start at age 50, you would have a 35% reduction in MACE. If you were to start at age 30, you would have a 52% reduction in cardiovascular event rates (MACE).

Next time someone asks you if it’s too late to start, you can show them the graphs and references from this paper by the World Heart Federation. Highly recommend you read it.

https://globalheartjournal.com/articles/10.5334/gh.1154 

 Graphic: Benefit of reducing cumulative exposure to LDL on the lifetime risk of atherosclerotic cardiovascular disease. Panel A shows the effect of reducing LDL by 50% from a population median of 3.5 mmol/L (135 mg/dl) resulting in an absolute difference of 1.75 mmol/L (67.7 mg/dL) on the lifetime risk of experiencing a major atherosclerotic cardiovascular event (defined as fatal or non-fatal myocardial infarction, fatal or non-fatal ischemic stroke, or coronary revascularization) if LDL lowering is started at ages 30, 40, 50 or 60 years and continued up to age 80 years as compared to either no LDL reduction of lifelong exposure to the same magnitude of lower LDL. Panel B shows the effect on the lifetime risk of experiencing a major atherosclerotic cardiovascular event up to age 80 years from reducing LDL by 33% beginning at age 40 years, or by 50% beginning at age 55 years. Greater benefits are observed if LDL-C lowering is begun at an earlier age.

The absolute risk in cardiovascular events tracked directly with the absolute reduction in LDL cholesterol.

Events avoided based on baseline absolute risk and absolute lowering of LDL-C (Duality of risk and LDL-C lowering as determinants of benefit from lipid lowering therapies). Adapted from CTT Lancet 2012 The effects of lowering LDL cholesterol with statin therapy in people at low risk of vascular disease: Meta-analysis of individual data from 27 randomised trials

What About Frail Elderly?

Another study from December 2023 showed that initiating statin therapy in “frail” Veterans, above the age of 65, reduced all-cause mortality, CV mortality, and MACE events. Statin use was associated with a 39% reduction in all-cause mortality.

Study:
https://agsjournals.onlinelibrary.wiley.com/doi/10.1111/jgs.18700

What About The Extremely Old? Over 75 And Up To 84 Years Old?

Another large retrospective cohort study of 326,981 participants found that new statin use was significantly associated with a 25% lower risk of all-cause mortality and a 20% lower risk of cardiovascular mortality in those over the age of 75.

https://jamanetwork.com/journals/jama/fullarticle/2767861

Association Between Statin Use and Major Cardiovascular Events in 326 981 US Veterans 75 Years and Older Free of Atherosclerotic Cardiovascular Disease at Baseline, Stratified by Diabetes, Dementia, and Arthritis:

Every single person, subgroup, and disease state benefitted from statin use over the age of 75!

What About Those Over The Age of 85?

Another study from May 2024 showed that statins used for primary prevention in the “old and very old” still demonstrated benefit without increasing risks for severe adverse effects. They defined old as 75-84 years of age, and very old as over 85 years of age.

Study:
https://www.acpjournals.org/doi/10.7326/M24-0004

As you can see above, every single age group had a reduction in risk, regardless of what age they began lipid lowering therapy. Including those over the age of 85!

Lipid Lowering At Any Age Confers Significant Benefit

As you can see from the studies, when you don't cherry pick studies and include all of them, everyone at every age benefits from lipid lowering therapy. You can ignore anyone that says that lowering cholesterol over the age of 60 does not provide benefit. That simply isn't true.

Send this to anyone who is wondering if they are too old to start a lipid lowering medication!