Cholesterol Rx and Stroke: The Effects on Older Patients

Statins and fibrates used to lower cholesterol might lower stroke risk in older patients

/ Author:  / Reviewed by: Joseph V. Madia, MD Beth Bolt, RPh

(RxWiki News) If you have to take a pill for high cholesterol, it would be nice to know that it does double duty. New evidence suggests that for healthy older patients, cholesterol drugs might have some benefits beyond just lowering cholesterol.

New research from France found that medications used in older adults to lower cholesterol may reduce stroke risk. The authors of this study followed people over the age of 65 for several years. They compared the death rate from stroke for those who took statins (brand names Crestor, Lipitor, Zocor) and fibrates (brand name Tricor).

“In other populations more exposed to the risk of stroke, a one third reduction in stroke risk, if confirmed, could have an important effect on public health," said lead study author Dr. Christophe Tzourio, of the University of Bordeaux and Institut National de la Santé et de la Recherche Médicale (INSERM), in a press release.

Sarah Samaan, MD, a board-certified cardiologist and physician partner with the Baylor Heart Hospital in Plano, TX, told dailyRx News that this study is important because it looked at older adults taking statins.

"Seniors in this age group are often excluded from participating in larger scale trials of medications, so it's great that we have an opportunity to discover what impact statin use can have in older folks when prescribed in a typical fashion ... the fact that statin drugs appeared to reduce the risk by 30% may have far reaching implications not only in terms of lives saved, but also disability avoided and quality of life preserved," Dr. Samaan said.

Dr. Samaan added, "We often hear about negative side effects of commonly prescribed medications like statins, yet it's important to understand why the drugs are prescribed, and what benefits they may have in different groups of people. This particular population was apparently relatively healthy at the outset, as none of them had underlying cardiovascular disease when the study began."

In high-income countries, heart disease and stroke are some of the most common causes of death in older patients.

Most clinical trials of heart disease medications do not include older adults. Many older adults are prescribed medications to lower their cholesterol, however.

Dr. Tzourio and colleagues decided to research whether stroke deaths declined when healthy older people took cholesterol-lowering drugs. These researchers tracked over 7,000 men and women with no known history of heart attack or stroke.

In addition to looking at data about the patients’ medications, Dr. Tzourio and team tracked health status. They also tracked education, income, occupation and lifestyle. Patients were followed for an average of nine years.

Dr. Tzourio and team found that the use of cholesterol-lowering medications may decrease stroke risk by 30 percent.

“This is the first observational study to describe a significant association between use of lipid lowering drugs and decreased risk of stroke … the results are sufficiently compelling to justify further research testing the hypothesis that lipid lowering may be effective in the primary prevention of stroke in older people," wrote Dr. Graeme J. Hankey, professor of neurology at the University of Western Australia, in an editorial about this study.

Dr. Hankey added, "Meanwhile, for clinicians and patients, the decision to start statins for primary prevention of vascular disease in people over 75 continues to be based on sound clinical judgment after consideration of each person’s predicted vascular risk without and with statins, the predicted risk of adverse effects of statins.”

Dr. Samaan said the findings of the current study affirm her thoughts on cholesterol-lowering drugs.

"This study won't change my practice, but it does give me added reason to feel good about prescribing statins for the most elderly of patients," Dr. Samaan said.

The study and editorial were published May 19 in The BMJ.

Several sources funded this research, such as INSERM, the Victor Segalen-Bordeaux II University and Sanofi-Aventis, which makes cholesterol-lowering drugs.

Several authors disclosed potential conflicts of interest. Dr. Annick Alpérovitch received honorariums for reviewing research projects for the French National Medicines Agency and others. Dr. Stéphanie Debette received research support from the Agence Nationale de la Recherche and the Fondation Leducq. Dr. Tzourio received research support from Agence Nationale de la Recherche and Fondation Plan Alzheimer. Dr. Tobias Kurth received funds from the French National Research Agency and the National Institutes of Health, among others.

Review Date: 
May 18, 2015
Last Updated:
May 19, 2015