Principal Investigator: Professor Martin Gulliford
Lead institution: King’s College London
Award amount: £112,965 over 2 years
Dr Rathi Ravindrajah, Research Assistant
Should we be prescribing or stop prescribing statins in people over eighty years?
Professor Martin Gulliford’s grant from the Dunhill Medical Trust investigated this important question and the research associate employed on the grant, Dr Rathi Ravindrarajah, discussed the results of this project in the September British Geriatric Society newsletter, following up their paper in Age and Ageing.
Statin use is controversial, especially for very old people. Do older patients benefit from starting or continuing statin treatment to prevent cardiovascular disease (CVD)? Should very old people discontinue statin treatment that they had begun when younger? There is limited evidence to answer these questions because most randomised controlled trials have focused on people aged younger than 80 years old.
In this recent study the research team investigated current practice by analysing rates of starting statin prescription and rates of discontinuation in people aged 80 years and over. They analysed electronic health records data for a cohort of 212,566 participants aged ≥80 years registered with UK general practices.
The study found that:
- the proportion of men over 80 using statins increased from 12% in 2001 to 55% in 2015 and from 9% to 46% in women. Even among centenarians, 12% were prescribed statins.
- Statin prescribing was more frequent for frail individuals and people with secondary prevention indications, including pre-existing heart disease, stroke or diabetes.
- New use of statins (inception) was quite infrequent in the over-80s. The rate of statin inception was 2.4% per year and decreased with increasing age.
- The rate of statin deprescribing (defined as a final statin prescription more than 6 months before the end of the participant’s record) was 5.6% per year overall. The rate of deprescribing increased with age, reaching 17.8% per year in centenarians. Deprescribing also increased with higher frailty levels: 5.0% per year in ‘fit’ participants and 7.1% in ‘severe’ frailty.
The results appear paradoxical. On the one hand, the study has shown that statin use has increased rapidly in very old people. This reflects the widespread use of statins at younger ages, which is now being carried over into older ages. Conversely, the study found that it is quite uncommon for people over 80 to start statins. At this age, statins are gradually being discontinued – a process that increases with age.
These paradoxical findings highlight uncertainty concerning appropriate use of statins in the over-80s and the need for better evidence to inform clinical practice with respect to statin use and discontinuation for people aged ≥80 years.
Co-applicants on the grant were: Dr Alex Dregan, Professor Stephen Jackson and Professor Toby Prevost