Statin-driven low cholesterol safe in elderly men

Lowering cholesterol with statins in men over 70 years of age is safe and not associated with adverse cardiovascular outcomes according to a study published in Heart (doi: 10.1136/heartjnl-2019-315449).

Low levels of total cholesterol (TC) have been associated with adverse outcomes in older populations, but whether this phenomenon occurs when TC is lowered by statins has not been reported.

This Australian study followed 1289 men over 70 years without ischaemic heart disease for an average of six years. The relationship between TC and long-term major adverse cardiovascular events (MACE) was analysed and stratified by statin use.

In the group not on statins, low TC was associated with a higher rate of MACE, all-cause mortality, myocardial infarction and heart failure (p<0.001). This relationship was not seen in the group receiving statins. In the subgroup with a TC <4 mmol/L, those not on a statin had significantly increased rates of MACE (64.1% versus 36.7%, p<0.001) compared with those taking statin therapy.

According to the authors of the study, the results provide reassurance to men aged over 70 years that taking statins does not appear to increase their risk of cardiovascular disease. The results do suggest that low cholesterol in those not on statins is a risk factor for adverse events in older men and that this requires explanation, they say.

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