Statin use (cholesterol-lowering drugs) lowered all-cause and cardiovascular mortality in US veterans: JAMA

photo courtesy of qimono (Arek Socha) via pixabay.com

A retrospective study of over 300,000 elderly veterans (almost all men) showed a 25% reduction in mortality rates over seven years in a study reported in the Journal of the American Medical Association.  This study is believable because it included a very large cohort of men observed over a long period of time.  Here are the results:

Results  Of 326 981 eligible veterans (mean [SD] age, 81.1 [4.1] years; 97% men; 91% white), 57 178 (17.5%) newly initiated statins during the study period. During a mean follow-up of 6.8 (SD, 3.9) years, a total 206 902 deaths occurred including 53 296 cardiovascular deaths, with 78.7 and 98.2 total deaths/1000 person-years among statin users and nonusers, respectively (weighted incidence rate difference [IRD]/1000 person-years, –19.5 [95% CI, –20.4 to –18.5]). There were 22.6 and 25.7 cardiovascular deaths per 1000 person-years among statin users and nonusers, respectively (weighted IRD/1000 person-years, –3.1 [95 CI, –3.6 to –2.6]). For the composite ASCVD outcome there were 123 379 events, with 66.3 and 70.4 events/1000 person-years among statin users and nonusers, respectively (weighted IRD/1000 person-years, –4.1 [95% CI, –5.1 to –3.0]). After propensity score overlap weighting was applied, the hazard ratio was 0.75 (95% CI, 0.74-0.76) for all-cause mortality, 0.80 (95% CI, 0.78-0.81) for cardiovascular mortality, and 0.92 (95% CI, 0.91-0.94) for a composite of ASCVD events when comparing statin users with nonusers.

(bolding applied to emphasize key points)

This study suggests that elderly men, regardless of their cholesterol levels, benefit from taking statins to improve their life expectancy.  Two-thirds of the men, who were around 80 years old at the start of the study, died over the 6.8 years that it ran.  17.5% of the men started taking statins during the study, and of these men, there was an all-cause death hazard ratio of 0.75– meaning that men were 25% less likely to die if they took a statin drug.

The statins most widely used are atorvastatin (Lipitor), rosuvastatin (Crestor), and simvastatin (Zocor), among many others.  The results of this study are no surprise and confirm the wide acceptance of these drugs among doctors.

The only limitations of the study are that it only includes men, mainly white men, and doesn’t address costs.  Despite this, women should probably take statins as well after menopause, when their risk of cardiovascular disease rises to nearly the same level as men.  The costs are now quite reasonable for these drugs, and Medicare pays the entire bill.

Non-white men, especially those with African-American or Caribbean-American heritage, should take statins as well, because their risks are higher than those of white men.  Black men should also carefully control their blood pressure, partly because discrimination has been shown to raise one’s blood pressure (sorry, I don’t have the citation, but it’s out there.)  High blood pressure also dramatically increases one’s risk of stroke, and the incidence of stroke is much higher in Black men.