An update has been issued for people taking atorvastatin after research was published by the European Society of Cardiology (ESC). The study found that atorvastatin reduced major cardiovascular events by 30% in older people without known cardiovascular disease, diabetes or dementia, but did not significantly improve disability-free survival.
What the drug is for
Atorvastatin is designed to lower high cholesterol and triglycerides in the blood and to help prevent heart attacks and strokes. Until now, the risk-benefit of statins to prevent cardiovascular events in older adults without known cardiovascular disease, diabetes, or dementia was uncertain due to underrepresentation in major statin trials.
In the UK, an estimated 7 to 8 million adults take statins. The National Institute for Health and Care Excellence says that around 5.3 million people in England alone were given a recommended statin or ezetimibe by their GP in 2023/24. The most frequently prescribed statins include atorvastatin, simvastatin, pravastatin, rosuvastatin, and fluvastatin.
Study details and findings
Lead Researcher, Professor Sophia Zoungas, from the Monash University School of Public Health and Preventive Medicine, Melbourne, Australia, said: "An estimated 21,000 older Australians suffer from major cardiovascular events, like heart attack and stroke, each year."
"The trial is the first large randomised controlled trial to examine whether statins can be used for primary prevention in older patients to help them live longer in good health."
The trial involved people aged 70 years and over with no history of clinical cardiovascular disease, diabetes or dementia. 9,971 participants were randomised (1:1) to oral atorvastatin 40 mg daily or placebo. The study population had a mean age of 74.7 years, and 52% were women.
Impact on health outcomes
The two main focuses of the research were major cardiovascular events, defined as cardiovascular death, nonfatal myocardial infarction, stroke or coronary revascularisation, and disability-free survival, defined as survival free of dementia and physical disability.
The researchers demonstrated that the risk of major cardiovascular events was reduced by 30% in the atorvastatin group compared with the placebo group over a median follow-up of 5.9 years. But the risk of death, dementia or persistent physical disability did not substantively differ between the two groups.
The ESC was told: "Muscle, liver and diabetes-related adverse events were more frequent in the atorvastatin group; however, all serious adverse events were uncommon, occurring in 2.7% of participants in both the atorvastatin and placebo groups."
Professor Zoungas said: "With the world’s population ageing at an unprecedented rate, answering fundamental questions about healthy longevity has become a universal imperative. The risk of heart attack and stroke is a concern for older people, and knowing there is an effective measure for lowering that risk will be a huge reassurance to older people and their families. We hope to see updated guidelines to help clinicians make use of these new findings."
