Statins and the Elderly

Cholesterol has long been known to be only a very weak cardiovascular risk factor for the elderly. Only in those elderly people with previous stroke or heart attack does the use of a statin show clear benefit and it is evident regardless of cholesterol response during statin use.

Even in cases where cholesterol remains the same or increases during statin treatment, reduction of cardiovascular risk is evident. This is not so for the elderly without history of heart disease or diabetes. This lack of significant cardiovascular benefit from the use of statins for cholesterol reduction in the elderly of minimal to moderate risk, has been corroborated in many studies.

The first clue to this enigma was brought out in the year 2000 by Uffe Ravnskov, author of The Cholesterol Myths. In this book Ravnskov revealed his growing suspicion that statin drugs appear to work to lower cardiovascular risk by an effect independent of cholesterol.

His findings have led directly to the current awareness that statins work by a previously unsuspected anti-inflammatory effect helping to explain why their use is so much more effective in high-risk persons than those with simple cholesterol elevation.

One of the many randomized control trials of the benefits of statins for the primary prevention of heart disease in patients over the age of 70, the Prosper Study, deserves special mention concerning side effects of statin drugs. This study found no benefit from the use of statins in elderly patients as to their risk of having a new heart attack but reported an ominous and statistically significant 25% increase in cancer diagnoses among those using a statin.

Interestingly enough this relates to the special anti-inflammatory effect of statin drugs - the same effect that decreases cardiovascular risk. The mechanism of action whereby statins achieve this risk reduction comes from their newly recognized ability to inhibit nuclear factor kappa B (NF-kB). This vital transcription factor is the basis of our entire immuno-defense system.

To inhibit NF-kB may be good for our arteries but what of our ability to defend ourselves from bacteria, viruses and malignancies. The Prosper study was not the first to demonstrate this dark side of statins. The Japan lipid intervention study group also reported unusual numbers of malignancies in their 45,000 patients on relatively low doses of Zocor.

Duane Graveline MD MPH
Former USAF Flight Surgeon
Former NASA Astronaut
Retired Family Doctor

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