This is a plain English summary of an original research article. The views expressed are those of the author(s) and reviewer(s) at the time of publication.
People aged 70 and older who take statins live longer in good health than those who do not, regardless of whether they have cardiovascular disease, a modelling study found. Both standard and high-intensity treatment was cost-effective in this age group.
The researchers hope their findings will encourage clinicians to recommend statins for the 5 million or so older people in the UK who are not currently taking them.
More information about statins can be found on the NHS website.
The issue: Do people over 70 benefit from statins?
Statins are a group of medicines that can lower people’s risk of cardiovascular conditions (including heart disease and stroke) by reducing levels of harmful cholesterol (low-density lipoprotein or LDL cholesterol. According to the British Heart Foundation, statins are one of the most prescribed drugs in the UK; around 7 – 8 million adults take them. People are usually prescribed statins if they are diagnosed with cardiovascular disease or have a high chance of developing it over the next 10 years.
The risk increases further with age but only around 40% of people aged 70 and older in England are prescribed a statin. Previous research suggested that the benefit of statins in this age group could be offset by even a small increase in adverse effects. But a more recent analysis highlighted the safety and effectiveness of statins in older people.
The current study modelled the effects and cost-effectiveness of statins in people aged 70 and older using recent data.
What’s new?
Researchers analysed data from 20,122 UK adults aged 70 years and older who had contributed data to large health studies (UK Biobank and Whitehall II). Most were white (97%), more than half were male (56%), and most (15,019) had no history of cardiovascular disease.
In previous work, the researchers developed a model (the Cardiovascular disease microsimulation model) to predict participants’ years in good health (quality-adjusted life years or QALYs) and healthcare costs (2021 prices for generic statins). They considered standard intensity treatment (which reduces LDL cholesterol by 35 – 45%; for instance, 20mg atorvastatin daily) and high-intensity treatment (which reduces LDL cholesterol by 45% or more; such as 40 – 80mg atorvastatin daily).
The study projected that, across groups of men and women aged 70 and older with different levels of LDL cholesterol before treatment, compared with not taking statins:
- standard statin therapy would add between 3 and 8 extra months in good health
- high-intensity statin therapy would add a further 0.5 to 1.6 months in good health.
The benefits of statins varied but were greatest in men without cardiovascular disease but with higher levels of LDL cholesterol before treatment.
Both intensities were likely to be cost-effective. Compared to not taking a statin:
- standard statin therapy cost between £116 and £3,502 per year of good health
- high-intensity statin therapy cost between £2,213 and £11,778 per extra year of good health further to standard statin therapy.
Statins were cost effective for all groups with greatest cost-effectiveness among those at highest risk (men with cardiovascular disease or high levels of LDL cholesterol).
Why is this important?
The findings suggest that prescribing older people statins increases their years in good health and is cost-effective. Both standard and high-intensity treatments are beneficial and cost-effective.
Earlier research showed that side-effects reported in randomised controlled studies of statin therapy were also reported by people not taking statins. More data on statin use in older people will be helpful, but the researchers say their findings suggest delaying statin treatment in millions of older people while waiting for new evidence is not justified.
Few data were available in this study for people older than 75 years with no history of cardiovascular conditions (3149 people; 21% of all participants). Statins remained beneficial and cost-effective for these people, but the small number of people in this group in the study means this finding is also less certain.
What’s next?
More research is ongoing and 2 studies are scheduled to complete in 2026. They will add to the evidence about statin use in people aged 75 years and older who do not have atherosclerotic cardiovascular disease (narrowed arteries).
How does this research fit with my current practice?
You may be interested to read
This is a summary of: Mihaylova B, and others. Lifetime effects and cost-effectiveness of statin therapy for older people in the United Kingdom: a modelling study. Heart 2024; 110: 1277 – 1285.
Mihaylova B, and others. Assessing long-term effectiveness and cost-effectiveness of statin therapy in the UK: a modelling study using individual participant data sets. Health Technology Assessment 2024; 28.
Burns, C. Statin prescribing in England at record high, show NICE data. Pharmaceutical Journal 2024; 313.
Statins do not commonly cause muscle pain and stiffness. An NIHR Evidence summary. 18 October 2021.
Funding: Health Technology Assessment Programme Commissioned Call, with support from Health Care Research Wales.
Conflicts of Interest: Several of the study authors have received funding from pharmaceutical companies. See paper for full details.
Disclaimer: Summaries on NIHR Evidence are not a substitute for professional medical advice. They provide information about research which is funded or supported by the NIHR. Please note that the views expressed are those of the author(s) and reviewer(s) at the time of publication. They do not necessarily reflect the views of the NHS, the NIHR or the Department of Health and Social Care.
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