Statin Use in the Elderly

Statin drugs, prescribed to lower cholesterol levels, are among the most widely prescribed drugs. Ads for the various brands used to be inescapable, but now that most of them have come off patent protection Crestor is the only one you’ll still see promotions for.

There’s no doubt that statin drugs do what they are intended to do: lower blood levels of cholesterol. The question ever since the first of these drugs was introduced, though (Mevacor/lovastatin in 1987) has been, “So what?” That is, what’s the benefit to the patient? The claim was that, because high cholesterol was associated with heart disease and heart attacks, lowering a person’s cholesterol level ought to reduce their risk of heart trouble. Except that, well, it didn’t work out that way. Patients on cholesterol-lowering medications tend to have roughly the same risk of heart disease as patients not taking the drug.

Overuse of Statins Is a Chronic Problem

Given that statins in general don’t seem to have much of an effect on their main endpoint (reduction of heart disease), there’s been lots of concern about their overuse. There’s extra concern about use of the drugs in populations that typically haven’t been included in clinical trials, namely the very young and the very old.

Now the use of drugs to lower cholesterol in children is shocking in itself, and a topic for another time. But a report published this week in the online version of JAMA Internal Medicine says that statin use among the very elderly—those age 80 and above—has increased significantly between 1999 and 2012, rising from 8.8% in 1999–2000 to 34.1% in 2011–12. As I said, there’s been little research into the benefits and—especially—the risks of statin use in this age group. (By the way, both my parents turned 81 this year. They finally consider themselves elderly. I’m not so sure about very elderly.)

For those of you in this age group, or who are caring for someone who is, it may be time to ask the doctor if this drug is necessary. As we age our bodies process drugs differently. In addition, we begin to lose our ability to cope with stresses, such as the effects of drugs. And data from the CDC shows that more than a third of all people over age 60 are taking 5 or more prescription drugs. That’s quite a load on a body.

If I had to guess, I’d say that the increase in use among this age group has more to do with inertia than anything else. They were given a script for a statin 20 years ago, and they’re still on it because nobody has said, “That’s enough.”

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