Lipid lowering drugs and risk of vascular events in older patients

Although elderly patients are at higher risk of cardiovascular events, the majority cardiovascular trials exclude these patients.  Accordingly, little is known about the use of lipid lowering medications for prevention of cardiovascular events in elderly populations. This prospective cohort study evaluated the association between use of statins or fibrates for prevention of vascular events among a random sample of 7484 patients aged 65 years of older without prior vascular disease living in three French cities recruited from 1999-2000.  Patients were followed for a median of 9.1 years, with 732 vascular events (440 coronary events, 292 strokes) occurring during the study period.  The study found that 27.4% (n=2084) of patients reported baseline lipid lowering medication use (13.5% statins, 13.9% fibrates).  Patients using lipid lowering medications were more likely to have other cardiovascular risk factors (diabetes, hypertension, hyperlipidemia) or diagnoses (dysrhythmia).  After risk-adjustment, the use of a statin or fibrate was not associated with decreased vascular events (hazard ratio 0.91, 95% CI 0.76-1.09) in this population.  However, use of lipid lowering agent was associated with a reduced risk of ischemic stroke (hazard ratio 0.66, 95% confidence interval 0.49 to 0.90).  Results did not differ significantly when considering changes in the use of lipid lowering drugs during the first 7 years of follow-up, and were similar in secondary analyses including patients with a prior vascular event.

Conclusions: In summary, this study of elderly patients demonstrated that use of a statin or fibrate medication was associated with a decreased risk of ischemic stroke, but not coronary heart disease. Additional study is needed to fully appreciate the risk versus benefit tradeoff of these therapies in older individuals.

Summarized by Javier A. Valle and Steven M. Bradley

  • Alpérovitch A, Kurth T, Bertrand M, Ancelin ML, Helmer C, Debette S, Tzourio C. Primary prevention with lipid lowering drugs and long term risk of vascular events in older people: population based cohort study. BMJ. 2015 May 19;350:h233