Do I still need to keep taking a statin?

Q. I'm 81 years old, and I've been on a statin drug for 30 years because I'm at increased risk for heart disease. At my age, do I need to still keep taking it?

A. Statin drugs were introduced into medical practice in the 1980s. They are very effective at lowering LDL (bad) cholesterol and in reducing inflammation inside cholesterol-filled plaques of atherosclerosis. In people older than 75, are they still effective in lowering cholesterol and in reducing the risk of heart disease? In the last few years, we have started to get solid information that addresses your question.

A recent study from Denmark, published in the August 2023 issue of Annals of Internal Medicine, included about 84,000 people — about 10,000 of whom were older than 75. Participants began taking one of two different statin drugs, simvastatin (Zocor) or atorvastatin (Lipitor), between 2008 and 2018. The study found that the people most likely to have their LDL cholesterol lowered by statin drugs were those older than 75.

So, statins remain effective at lowering cholesterol in people older than 75. But do they also reduce the risk of developing heart disease? Another observational study from Denmark, published in The Lancet in 2020, identified more than 90,000 people not on statins who were free of heart disease or diabetes (a risk factor for heart disease) — and then started taking a statin drug. Over an average follow-up period of 7.7 years, the people who were most likely to benefit from statin drugs were those older than 75.

Randomized trials provide stronger evidence than observational studies. However, relatively few randomized trials of the ability of statins and other cholesterol-lowering drugs to reduce heart disease risk have included people older than 75. To overcome that problem, an international team based here at Harvard pooled the results for more than 21,000 people older than 75 (and even more who were younger than 75) from multiple different cholesterol-lowering drug trials. The study, published in 2020 in The Lancet, found that the older group benefited at least as much as the younger group.

In short, for people older than 75 who have heart disease already, or who, like you, are at increased risk of developing heart disease, I think there now is solid evidence that statins remain effective at lowering cholesterol and, more important, in reducing the risk of new or recurrent heart disease. For people older than 75 who have not been diagnosed with heart disease and are not at increased risk for developing it, I think the value of statins still is uncertain.

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