According to the Centers for Disease Control and Prevention (CDC), heart disease is the leading cause of death for both men and women in the United States. Two of the biggest risk factors for heart disease are high blood pressure (high blood pressure) and high cholesterol. Lifestyle changes such as eating a healthy diet, regular exercise, and quitting smoking can help improve both.

If lifestyle changes don’t seem to be working, medicines can help. For high cholesterol, the most prescribed medications are known as statins. The CDC’s Million Hearts Initiative estimates that statins can reduce the risk of heart attack and stroke by 50%. However, not everyone who would benefit from a statin is prescribed the drug.

“Despite their effectiveness, statins are not widely prescribed to people without a history of heart disease. “There were questions, in part because there was a lack of patient data. There were also concerns about side effects,” explains Ariella Orkabee, MD, MPH, a geriatrician in Brigham, Massachusetts. Geriatricians specialize in treating older patients, and Dr. Orkabi cares for patients at Brigham and Women’s Hospital.

Dr. Orkaby and colleagues recently published research on statins that shows promising results. One study showed that statins may prevent heart attacks and strokes in patients with chronic kidney disease (CKD). Other studies have found that statins reduce the risk of heart attack, stroke, and death in older adults with a condition known as frailty. Frailty in older adults occurs when they become weaker and daily life becomes more difficult. These two groups of people are both at high risk of developing heart disease in the future, even if they do not currently have high cholesterol or heart disease.

Dr. Orkabi’s research shows that statins can help reduce the risk of heart attack and stroke in even more patients.

What are statins?

The liver produces cholesterol. This is a type of fat that carries molecules and other chemical signals through the bloodstream. It is also a component of vitamin D, hormones, and cell membranes. The liver uses building blocks from food, such as sugars and fats, to produce cholesterol. Too much extra cholesterol in your diet can cause cholesterol to build up in your arteries and cause coronary artery disease.

Statins act in the liver to prevent cholesterol production. Statins also help the liver lower the levels of cholesterol already in the blood. It lowers levels of LDL, commonly known as “bad” cholesterol, and increases levels of HDL, commonly known as “good” cholesterol. Although other drugs can help manage cholesterol levels, statins are the most widely used and most effective. Statins can take up to 2.5 years to take full effect. The longer you take a statin, the more effective it is.

Research on statins and chronic kidney disease (CKD)

Heart disease is the leading cause of death in older adults with CKD, but these patients have not been included in many trials investigating statins. It was unclear whether statins would help prevent heart disease in patients with CKD and no history of heart disease.

Dr. Orkabi and her colleagues analyzed the effects of statins on a group of approximately 15,000 veterans aged 65 and older. They all had CKD but no history of heart disease. They used data from the medical and insurance systems to simulate a trial in which doctors would prescribe a portion of a group of statins. The control group did not take statins. The group prescribed statins had a 9% lower risk of dying from any cause.

“Further research, including randomized clinical trials, needs to be done, but these results are very promising. The data show that patients with CKD may benefit significantly from starting statins.” ,” says Dr. Orkabi.

Research on statins and frailty in the elderly

As people age, it’s natural for their bodies to change and no longer function as they used to. Although not all older adults experience frailty, those who become frail are at increased risk of falls, disability, needing hospital care, and death. Being frail is also a risk factor for heart disease. Frailty can become a vicious cycle. Frailty makes it difficult to participate in activities and exercise that can help prevent frailty in the first place. Frailty can also be exacerbated by chronic diseases such as diabetes and dementia.

Signs and symptoms of frailty include:

• walking speed slows down

• Feeling of weakness and decreased grip strength

• unintentional weight loss

• decreased physical activity

• Malaise

“Frailty itself is a risk factor for heart disease, but it is not traditionally considered when assessing risk,” Dr. Orkaby points out.

Like older adults with CKD, frail older adults are not included in many studies of statins. “The 2014 Cholesterol Guidelines ended at age 75 because studies did not include many people over 75 and few people who were frail. “There is no magic cutoff for high cholesterol levels or risk of heart attack or stroke. Older patients, especially those who are frail, may still benefit,” Dr. Orkabi explains.

In Dr. Orkabi’s study, she and colleagues examined the health records of more than 710,000 veterans from 2005 to 2017. They identified more than 86,000 patients who were identified as frail. They analyzed heart disease outcomes in her two groups: patients who were prescribed statins and frail patients who were not. Their results showed that frail adults taking statins had a 39% lower risk of death and a 14% lower risk of a first heart attack or stroke.

“Frail people are at the highest risk of heart attack, stroke, and death, so they may benefit the most from continuing to take statins,” Dr. Orkaby says.