Are statins beneficial for older people?
For a start it is controversial whether high cholesterol is a problem in people over 70 years of age. A study called “Cholesterol and mortality: 30 years of follow-up from the Framingham study” was published in the Journal of the American Medical Association in 1987. Cholesterol levels were measured in 1959 men and 2415 women aged between 31 and 65 years of age, who were free of cardiovascular disease and cancer. You may be shocked to know that the study showed there was no increased death rate in people with high cholesterol over the age of 50. So if you make it to 50 years of age, you are not more likely to die of a heart attack if you have high cholesterol than people who have normal or low cholesterol, according to this study. In the study there was a direct association between low levels of cholesterol and increased death.
Researchers at the San Diego School of Medicine found that high cholesterol in people over 75 years of age is protective, instead of harmful. They also stated that low cholesterol is a risk factor for heart arrhythmias, or heart rhythm irregularities. A study in the European Heart Journal recruited 595 people with coronary heart disease who had a total cholesterol level of 4.1mmol/L or less; they were compared with a group of 10 968 people with heart disease who had a cholesterol level above 4.1mmol/L. The study found that the risk of cardiac death was the same in both groups. Therefore, there was no protective benefit to having a low cholesterol level. The study found that “the most frequent cause of non-cardiac death associated with low total cholesterol was cancer”. What is the point of worrying about getting your cholesterol down when it won’t help you to live any longer? Elderly patients are more susceptible to side effects caused by statin drugs. One reason for this is that older people are more likely to take several medications, making drug interactions more likely to happen. Statin induced muscle soreness (myopathy) is more common as we get older, the more other medications we take, the more other diseases we have, and during postoperative periods. All of these factors are more prevalent in the elderly. Muscle pain makes people less likely to exercise; therefore they miss out on the cardiovascular benefits it provides.
Statins without a prescription
In 2004 a low dose version of the cholesterol lowering drug Zocor became available without a prescription in the UK. The theory behind this move was to make statins more widely available to the public, in order to prevent heart disease in at risk individuals. Dr John Reckless, chairman of Heart UK believes statins are safer than aspirin, and “rather more people do need statins than are currently getting them”.
Statins can of course have serious side effects, and this move will place an unnecessarily high number of people at risk. They should never be used by pregnant women because they can cause limb defects. Professor Tom Sanders is a nutritionist at King’s College, London, and nutrition director for Heart UK. According to Professor Sanders, “At the age of 40, your risk of having a heart attack is below one in 1, 000, so any reduction is really quite miniscule in terms of benefit”. Unfortunately, being able to buy Zocor over the counter reinforces the idea that we can eat what we like and never exercise, and a pill will undo the damage.
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