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              IS THERE AN AGE LIMIT TO THE BENEFIT OF STATINS 
                  FOR PREVENTION OF CARDIOVASCULAR EVENTS?
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Lorraine Lipscombe, MD, MSc
Dominic S. Ng, MD, FRCPC, PhD
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OBJECTIVE: To critically review the evidence for the prevention of coronary 
events with statin treatment in the elderly.
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DATA SOURCE: Trials were retrieved by searching MEDLINE
(January 1966 to September 2001) and reference lists from relevant trials 
and review articles.
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STUDY SELECTION: Studies had to include participants aged 65 years or more 
who were randomly assigned to statin or placebo treatment for at least one 
year and in whom cardiac events or death was the primary outcome. Studies 
comparing different statins, different target lipid levels or doses and 
nonclinical endpoints were excluded.
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DATA EXTRACTION: The Medical Subject Headings: statins, HMG CoA reductase 
inhibitors, lovastatin, pravastatin, simvastatin, fluvastatin, atorvastatin 
or cerivastatin, combined with coronary disease, cardiac disease, 
myocardial infarction, ischemia, ischemic or cardiovascular disease, and 
prevention - retrieved 180 citations. The abstracts or full-text articles 
were reviewed for relevance.
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DATA SYNTHESIS: Data were included from three trials on secondary 
prevention of coronary heart disease (CHD) with 17,617 participants, 
5818 (33%) of whom were aged 65 to 75, and one primary prevention trial 
with 6605 subjects, 1387 (21%) of whom were aged 65 to 73. The duration 
of treatment was between 5.0 and 6.1 years. Statin treatment for secondary 
prevention reduced the incidence of major coronary events by 24% to 30%, 
with similar results in patients under age 65 and 65 to 75 years old. 
The absolute risk reduction tended to be greater in patients 65 or older 
than in those younger than 65 (4.7% to 9.8% v. 1.5% to 8.3%). Statin 
therapy for primary prevention of CHD was associated with a 37% reduction 
in the incidence of coronary events; there was no difference between those 
younger than the median age (57 years in men and 62 years in women) and 
those between the median age and 73 years old.
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CONCLUSIONS: Statin therapy is beneficial for the primary and secondary 
prevention of coronary events in patients up to age 75, and the relative 
risk reduction is similar in older and younger patients. For secondary 
prevention, the absolute risk reduction appears to be larger in the older 
patients.
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KEY WORDS: hypercholesterolemia, coronary disease, statin, HMG-CoA 
reductase inhibitors, elderly
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Drs. Lipscombe and Ng are from the Department of Medicine, University of 
Toronto, and St. Michael’s Hospital. Address correspondence to: 
Dr. D. S. Ng, St. Michael’s Hospital West Annex 2-015, 38 Shuter Street, 
Toronto, Ontario, Canada M5B 1A6. Received for publication October 2, 2001. 
Accepted December 15, 2001. This article has been peer-reviewed. 
Competing interests: None declared.
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