Meta-analysis · Lancet 2019
CTT 2019 older people
Efficacy and safety of statin therapy in older people: a meta-analysis of individual participant data from 28 randomised controlled trials.
The bottom line
Statins reduce major vascular events across all age groups including older people, though the evidence for benefit beyond age 75 without pre-existing vascular disease is less direct and being addressed by further trials.
BenefitUS status: Not applicable
At a glance
- Medicine
- Statin therapy or more intensive statin regimen
- Compared with
- Control or less intensive statin therapy
- People
- 186,854
- Who took part
- Participants in 28 randomised statin trials, subdivided into six age groups (≤55, 56-60, 61-65, 66-70, 71-75, >75 years); 14 483 (8%) of 186 854 participants were older than 75 years at randomisation
- Design
- Meta-analysis of individual participant data from randomised controlled trials of statin therapy versus control and more intensive versus less intensive statin therapy
- Follow-up
- median follow-up duration was 4·9 years
- Main question
- Major vascular events (major coronary events, strokes, and coronary revascularisations), cause-specific mortality, and cancer incidence, expressed as rate ratio per 1·0 mmol/L reduction in LDL cholesterol
Main result
Statin therapy or a more intensive statin regimen produced a 21% (RR 0·79, 95% CI 0·77-0·81) proportional reduction in major vascular events per 1·0 mmol/L reduction in LDL cholesterol; proportional reductions diminished slightly with age but trend was not statistically significant (ptrend=0·06)
Effect on LDL cholesterol
Effects expressed per 1·0 mmol/L reduction in LDL cholesterol
Other results
12% (RR 0·88, 95% CI 0·85-0·91) proportional reduction in vascular mortality per 1·0 mmol/L reduction in LDL cholesterol, with trend towards smaller proportional reductions with older age (ptrend=0·004) that did not persist after exclusion of heart failure/dialysis trials (ptrend=0·2); statin therapy had no effect at any age on non-vascular mortality, cancer death, or cancer incidence
Safety
Statin therapy had no effect at any age on non-vascular mortality, cancer death, or cancer incidence
In the trial's own words
“Overall, statin therapy or a more intensive statin regimen produced a 21% (RR 0·79, 95% CI 0·77-0·81) proportional reduction in major vascular events per 1·0 mmol/L reduction in LDL cholesterol. We observed a significant reduction in major vascular events in all age groups. Although proportional reductions in major vascular events diminished slightly with age, this trend was not statistically significant (ptrend=0·06).”
Quoted from the abstract of Lancet 2019, checked word for word against PubMed. PubMed 30712900 · Full paper (DOI)
Common questions
What did the CTT 2019 older people trial find?
Statins reduce major vascular events across all age groups including older people, though the evidence for benefit beyond age 75 without pre-existing vascular disease is less direct and being addressed by further trials.
Who was in CTT 2019 older people?
186,854 people. Participants in 28 randomised statin trials, subdivided into six age groups (≤55, 56-60, 61-65, 66-70, 71-75, >75 years); 14 483 (8%) of 186 854 participants were older than 75 years at randomisation.
What was CTT 2019 older people's main result?
Statin therapy or a more intensive statin regimen produced a 21% (RR 0·79, 95% CI 0·77-0·81) proportional reduction in major vascular events per 1·0 mmol/L reduction in LDL cholesterol; proportional reductions diminished slightly with age but trend was not statistically significant (ptrend=0·06)
How much did LDL cholesterol change in CTT 2019 older people?
Effects expressed per 1·0 mmol/L reduction in LDL cholesterol
Related trials
- PCSK9/ezetimibe diabetes meta-analysis (2020)Neither PCSK9 inhibitors nor ezetimibe increase the risk of new-onset diabetes when added to guideline-directed medical therapy.
- CTT 2022 muscle (2022)Statins cause a small, mostly mild excess of muscle pain primarily in the first year of treatment, with over 90% of muscle symptom reports in statin users not actually due to the statin, and this risk is far outweighed by cardiovascular benefits.
- CTT 2024 diabetes (2024)Statins cause a modest, dose-dependent increase in new-onset diabetes and worsening glycaemia, driven by small upward shifts in glucose/HbA1c, but this risk is already outweighed by the overall cardiovascular benefit of statin therapy.
- CTT 2012 low risk (2012)Even in people at low baseline cardiovascular risk, lowering LDL cholesterol with statin therapy reduces major vascular events and all-cause mortality without increasing cancer risk, suggesting current risk-threshold guidelines for statin use may need reconsideration.
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