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Statins Beneficial for Elders

Men and women who were 70 or older and who had vascular disease or risk factors benefited from 3-year treatment with pravastatin.

The value of statins for elders is unclear, because statin research has focused on middle-aged men and because low cholesterol levels have been associated with increased mortality in older people. In this industry-supported, randomized, European trial, researchers determined whether pravastatin reduced risk for cardiac events, stroke, cognitive decline, or disability in older people with existing vascular disease or risk factors.

Nearly 6000 men and women (age range, 70-82) with vascular disease or risk factors were allocated to pravastatin (40 mg daily) or placebo. Mean LDL cholesterol level (147 mg/dL [3.8 mmol/L] at baseline) was lowered by about 34% in the pravastatin group during the study. During an average follow-up of about 3 years, the incidence of the primary composite endpoint (coronary death, nonfatal myocardial infarction, or fatal or nonfatal stroke) was significantly lower in the pravastatin group than in the placebo group (14.1% vs. 16.2%). Coronary death and nonfatal MI were reduced significantly, but stroke was not. Cognitive function and disability were not affected significantly. New cancers occurred significantly more often in the pravastatin group than in the placebo group (8.5% vs. 6.8%).

Comment: These results confirm that pravastatin reduces risk for coronary disease in elders -- a benefit known to exist for middle-aged people. The editorialists note that the 15% risk reduction achieved in this study was lower than the reductions in other trials (about 25%) but point out that this could be due to chance or to the short duration of this trial. Although other trials generally have not yielded an excess of cancers in statin groups, additional analyses of cancer risk for older statin users should be conducted. At the time of publication, the full text of the original articles was available at http://www.thelancet.com/journal/vol360/iss9346/full/llan.360.9346.original_research.23196.1 and http://www.thelancet.com/journal/vol360/iss9346/full/llan.360.9346.editorial_and_review.23265.1 free of charge.

— Sir Brian Jarman, PhD, FRCP, FRCGP, FFPHM, FMedSci

Published in Journal Watch General Medicine January 7, 2003

Citation(s):

Shepherd J et al. Pravastatin in elderly individuals at risk of vascular disease (PROSPER): A randomised controlled trial. Lancet 2002 Nov 23; 360:1623-30.

• Medline abstract (Free)

Collins R and Armitage J. High-risk elderly patients PROSPER from cholesterol-lowering therapy. Lancet 2002 Nov 23; 360:1618-9.

• Medline abstract (Free)