Statins are being used “without any evidence from testing” among very elderly people in the US, with levels of prescribing rising from 8.8% in 1999-2000 to 34.1% in 2011-2012 for people who have no vascular disease.
The oldest age group, over 79 years, have the highest rate of statin use in the US, according to the study published in JAMA Internal Medicine, but this had not been investigated previously.
The research, carried out by Dr. Michael Johansen, of Ohio State University in Columbus, and Dr. Lee Green, of the University of Alberta in Canada, used data from the 1999-2012 Medical Expenditure Panel Survey.
The annual survey is nationally representative of the civilian population living in the community in the US – those who are not hospitalized.
The authors conclude:
“Although the medical community has embraced the use of statins for primary prevention in the very elderly, caution should be exercised given the potential dangers of expanding marginally effective treatments to untested populations.”
The survey sample included 13,099 individuals. The rates of vascular disease rose from 27.6% in 1999-2000 to 43.7% in 2011-2012.
“Despite a lack of clear recommendation for statin use in the primary prevention of the very elderly,” says the research letter, there was a “large” increase in the use of the cholesterol-lowering medications in spite of “little randomized evidence to guide the use.”
Primary prevention is defined as statin use in individuals without vascular disease – with no history of coronary heart disease (CHD), stroke or peripheral vascular disease (PVD).
Secondary prevention use is defined as prescription for those who already have vascular disease, the level of which prescribing increased in 2007 after questions became more frequently asked about CHD and stroke.
The survey used in the study consisted of five interviews over 2 years. Participants reported demographics, medical conditions and prescription drug information.
The analysis included all individuals older than 79 years without liver disease. Prescriptions were verified using pharmacy data.
The proportion of patients using atorvastatin peaked in 2005-2006 and then steadily declined, while the proportion using simvastatin was steady until 2007-2008 before rising. The proportion taking rosuvastatin steadily increased after introduction.
A journal editorial in July said that lowering cholesterol with statins had become an “unquestionable” means for lowering cardiovascular risk, but that the question had remained of “when, in whom and how to lower cholesterol.”
The article was commenting on a study finding that new guidelines have improved the treatment of high cholesterol.