Researchers have found that drugs taken to lower cholesterol were associated with a reduction in the risk of stroke by 30% among healthy older adults without a history of cardiovascular problems.
Statins are a class of medicines frequently used to lower blood cholesterol levels.
The findings of the observational study published in The BMJ suggest that if these results can be replicated, cholesterol-lowering drugs could be considered for preventing stroke among older populations.
A growing proportion of vascular events occur in the oldest people in high-income countries, the study authors write. In France, where the study was conducted, 43% of deaths from coronary heart disease and 49% of deaths from stroke occurred in people aged 85 years and older in 2010.
Most randomized controlled trials that are conducted to test cardiovascular drugs involve participants under the age of 70, however, meaning that the benefit of these drugs for older people who are widely affected by vascular events is still uncertain.
Drugs that lower cholesterol – such as statins and fibrates – are often used to prevent heart disease and stroke in older adults with a history of cardiovascular disease, but new guidelines based on data from randomized controlled trials do not recommend statin treatment for people aged over 75 without vascular disease.
Despite these guidelines, the study authors report that statins are commonly prescribed to older people without clinical evidence of vascular disease. As a result, the researchers set out to examine the association between cholesterol-lowering drugs and the risk of vascular events among a cohort of healthy older adults.
The researchers followed a total of 7,484 community-dwelling older adults with an average age of 74 living in the French cities of Bordeaux, Dijon and Montpellier. Each adult had no known history of vascular events, such as heart attacks or stroke.
Every 2 years, the participants were examined in person by trained nurses and psychologists, making physical and cognitive assessments in both the participants’ homes and at a study center. Data were collected concerning the participants’ sociodemographic characteristics, lifestyle and general health.
Findings ‘justify further research into lipid-lowering and stroke prevention’
The researchers found that after an average follow-up period of 9 years, use of statins or fibrates was associated with a 30% reduction in the risk of stroke when compared with participants that did not use these drugs. No association was observed between the use of cholesterol-lowering drugs and coronary heart disease.
After adjusting for other factors such as age, sex, body mass index (BMI) and blood cholesterol levels, the researchers found that these results remained.
“In a community-dwelling population of older people with no known history of vascular events, we found that use of lipid-lowering drugs at baseline was associated with a decreased risk of stroke during a mean follow-up of 9 years,” the authors write.
The researchers acknowledge that their study might be limited by the fact that the study’s participants may not be representative of wider populations. The study is also observational and, therefore, no definitive conclusions can be made regarding cause and effect.
Despite these limitations, the authors suggest the observed improvement in stroke risk among older adults could have an important effect on public health in populations where overall stroke risk is relatively high.
In an accompanying editorial, consultant neurologist Graeme J. Hankey, of the University of Western Australia, suggests that the study’s results are compelling enough to justify further research testing the hypothesis that lipid-lowering may be effective in the primary prevention of stroke in older adults.
“Alpérovitch and colleagues’ study reinforces the need for more robust evidence from large randomized trials evaluating lipid-lowering specifically in older people without previous vascular disease,” he writes.
Previously, Medical News Today reported on a paper published in the Journal of the American College of Cardiology in which leading cardiologists explore the choice of using statins in the long-term as a primary method of preventing heart attacks and strokes.
Written by James McIntosh
