Statins are among the most widely prescribed medicines for preventing heart attacks and strokes.
But for people in their late 70s and beyond who have never had cardiovascular disease, doctors have had surprisingly little strong evidence about whether taking a statin for the rest of life is necessary.
A randomized trial from France offers new information. Researchers found that adults aged 75 and older who stopped statins did not have a higher risk of death over the next three years than similar adults who continued taking the medicine.
Statins lower LDL cholesterol, often called “bad” cholesterol. High LDL can contribute to fatty deposits inside artery walls, gradually narrowing the arteries and increasing the chance of a heart attack or stroke.
There is strong evidence for statins in people who already have cardiovascular disease. In this situation, called secondary prevention, lowering LDL can reduce the risk of another serious cardiovascular event.
Statins are also used for primary prevention, meaning they are given to people who have never had a heart attack or stroke but may be at risk of developing one. Evidence supports this approach for many middle-aged adults, but older people have often been underrepresented in major clinical trials.
That evidence gap becomes increasingly important as people live longer. Older adults may take several medicines every day, and doctors must balance the possible long-term benefit of each treatment against side effects, medication burden, other illnesses and the person’s own priorities.
The French trial enrolled 1,160 adults aged 75 or older through general medical practices. None had a history of heart disease or stroke, and all were already taking statin medication for prevention.
Participants were randomly assigned either to stop their statin or to continue it. Random assignment is important because it makes the groups more comparable and provides stronger evidence than simply observing people who choose on their own whether to stop treatment.
After three years, 35 of 484 participants in the group assigned to stop statins had died, equal to 7.2%. In the group that continued treatment, 48 of 604 participants had died, or 7.9%.
The difference was not statistically significant. Researchers also found no significant difference between the two groups in major cardiovascular events such as heart attacks and strokes during the three-year follow-up.
Stopping the medicine did have a clear effect on cholesterol. After only three months, average LDL cholesterol in the discontinuation group had risen from about 115 mg/dL to 171 mg/dL, an increase of roughly 50%.
LDL levels remained essentially unchanged among people who continued their statins. This confirms that the drugs were still having a strong biological effect even though the trial did not detect a difference in deaths or major cardiovascular events over three years.
Quality of life was another important outcome. Researchers found no meaningful difference between the groups in measures of physical or mental quality of life during follow-up.
The findings need careful interpretation. Three years may be too short to reveal the full consequences of higher LDL cholesterol because atherosclerosis develops gradually, and the protective benefits of cholesterol lowering can build over many years.
The study also applies to a specific population: people aged at least 75 who had never experienced heart disease or stroke. It does not show that people with previous cardiovascular disease can safely stop statins, and the results should not be applied to younger patients without considering their different long-term risks.
Previous research in younger adults has shown that statins can reduce cardiovascular events and deaths when used for primary prevention. A 2013 Cochrane analysis of 18 trials, whose participants had a median age of about 57, reported a reduction in deaths among people taking statins.
The new randomized trial was published in The Lancet Healthy Longevity. It addresses an important question because relatively few statin trials have included large numbers of people older than 75, leaving doctors with less direct evidence for this age group.
The study’s strongest feature is its randomized design, which makes its comparison more reliable than many earlier observational studies. However, the follow-up was relatively short for a treatment intended to prevent disease that may develop over many years, so the long-term safety of stopping remains uncertain.
The findings therefore should not be read as a recommendation for everyone over 75 to stop taking statins. Instead, they support a more individual discussion about expected lifespan, cardiovascular risk, medication burden, personal preferences and the reasons the statin was prescribed.
For an older adult who has never had cardiovascular disease, the decision may be less straightforward than it is for someone who has already had a heart attack or stroke. More trials with longer follow-up are needed to determine whether the similar outcomes seen at three years continue five, ten or more years after statins are stopped.
If you care about heart health, please read studies about how drinking milk affects risks of heart disease , and herbal supplements could harm your heart rhythm.
For more information about heart health, please see recent studies about how espresso coffee affects your cholesterol level, and results showing Vitamin K2 could help reduce heart disease risk.
Source: French primary care research team.
