19 May Lipid-Lowering Drugs Substantially Reduced Stroke Risk In Elderly Population
Medical Research: What is the background for this study? What are the main findings?
Dr. Tzourio: The efficacy of lipid-lowering drugs (LLD) – which include statins and fibrates – to reduce the risk of coronary events and stroke has already been demonstrated in randomized trials. However, these trials were performed on highly selected patients, usually of middle-age (50-70 yrs) and with a history of cardiovascular disease or a high vascular profile. There is therefore currently no indication on the benefit of these drugs in elderly individuals of the general population without a past-history of cardiovascular disease and guidelines do not recommend the use of lipid-lowering drugs in elderly individuals without clinical atherosclerotic disease.
As there are not randomized trials in non-selected individuals in this age category, observational population-based cohorts are therefore the only alternative to study the impact of lipid-lowering drugs on the risk of cardiovascular diseases in the elderly.
We analyzed data from the Three-City study, a community-based cohort in 7484 elderly individuals (mean age 74 years), followed-up during 9 years, without known history of vascular disease at baseline. We observed a one third decrease in the risk of stroke in lipid lowering drug users (hazard ratio 0.66, 0.49 to 0.90) compared with non-users. Reduction in stroke risk was similar for the statin and fibrate groups. No protective effect was seen on the risk of coronary heart disease.
Medical Research: What should clinicians and patients take away from your report?
Dr. Tzourio: Observational studies are exposed to biases and despite all our efforts to perform a very careful analysis and to test the stability and consistency of our results, residual confounding might exist which could explain this apparent protection.
Therefore, our results should not be interpreted as an indication of prescribing lipid-lowering drugs in elderly individuals free of vascular diseases.
This finding needs to be confirmed before considering modifying the guidelines on lipid-lowering drugs in elderly individuals.
Medical Research: What recommendations do you have for future research as a result of this study?
Dr. Tzourio: There are several ongoing cohorts in the elderly. We suggest that investigators of these cohorts have a close look at the impact of lipid-lowering drugs in their participants. The confirmation or refutation of this result is important in terms of public health as stroke is one of the leading cause of death and disability.
Alpérovitch Annick, Kurth Tobias, Bertrand Marion, Ancelin Marie-Laure, Helmer Catherine, Debette Stéphanie et al. Primary prevention with lipid lowering drugs and long term risk of vascular events in older people: population based cohort study BMJ 2015; 350 :h2335
MedicalResearch.com Interview with: Christophe Tzourio, MD, PhD (2015). Lipid-Lowering Drugs Substantially Reduced Stroke Risk In Elderly Population MedicalResearch.com
Last Updated on May 19, 2015 by Marie Benz MD FAAD