Statins prove equally effective for older adults in preventing heart disease

Two large studies published this week in The Lancet upend a long-standing uncertainty about whether cholesterol-lowering drugs work as well in older bodies as they do in younger ones. The answer, researchers found, is that they work better—or at least, they work with more dramatic efficiency. For every eighty people between eighty and one hundred years old who take statins, one heart attack is prevented. To achieve the same prevention in people between fifty and fifty-nine requires treating two hundred and forty people. The gap is striking enough that it reframes how doctors might think about prescribing these medications to their oldest patients.

The research comes from two separate analyses, each substantial in scope. The first tracked more than ninety-one thousand adults in Denmark over roughly eight years, including nearly fourteen thousand people aged seventy to one hundred who were not taking statins when the study began. Researchers recorded first-time heart attacks, cases of heart disease, and LDL cholesterol levels throughout the follow-up period. The numbers were substantial: fifteen hundred and fifteen first-time heart attacks and thirty-three hundred and eighty-nine cases of heart disease emerged across the cohort. People seventy and older experienced the highest incidence of both conditions of any age group studied.

The mechanism is straightforward but important. For every one-point reduction in LDL cholesterol, people aged seventy-five and older saw their risk of heart attack and stroke drop by twenty-six percent. In younger people, the same reduction in LDL produced only a fifteen percent decrease in risk. The difference suggests that years of cholesterol accumulation in the arteries create a kind of debt that, when addressed, yields outsized returns. Børge Nordestgaard, a clinical professor of genetic epidemiology at Copenhagen University Hospital, framed it as evidence of cumulative burden—the longer cholesterol has been building up in someone's vessels, the more dramatic the benefit when you finally lower it.

The second analysis, conducted by researchers at Brigham and Women's Hospital in Boston, examined twenty-nine separate studies involving more than two hundred and forty-four thousand adults. Their findings aligned closely with the Danish work. In people seventy-five and older, cholesterol-lowering therapies reduced deaths from all heart disease causes by fifteen percent for every one-point LDL reduction, and lowered the incidence of heart attacks by twenty percent. No offsetting safety concerns emerged in the older population, according to Marc Sabatine, chairman of the Thrombolysis in Myocardial Infarction Study Group at Brigham and Women's Hospital.

The context for these findings is substantial. Up to twenty-nine percent of all American adults—roughly seventy million people—have high cholesterol, according to the Centers for Disease Control and Prevention. Statins, combined with diet and exercise, have long been the standard approach to managing it. Yet uncertainty has persisted about whether the drugs deliver the same benefit in older adults, partly because earlier research was less conclusive on the question. These two studies, taken together, suggest that uncertainty was misplaced.

But the researchers were careful to add an important caveat. The fact that older adults benefit so dramatically from statin treatment does not mean people should wait until they are elderly to start managing their cholesterol. The real prize, they emphasized, lies in keeping LDL cholesterol well controlled as early in life as possible, preventing the buildup in arteries before it accumulates into decades of damage. Nordestgaard noted that with the proportion of people living beyond seventy worldwide increasing rapidly, there is enormous potential for strategies aimed at lowering LDL cholesterol levels across populations. The drugs are affordable and have reduced heart disease risk for millions globally. What these studies show is that the benefit extends further into old age than anyone had clearly demonstrated before.