155. Lancet and Statin in the Elderly

https://www.clinicalkey.com/#!/content/journal/1-s2.0-S0140673620322339?scrollTo=%23hl0000424

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)32233-9/fulltext

do statins work in old people?? This study in the lancet says-

“In a contemporary primary prevention cohort, people aged 70–100 years with elevated LDL cholesterol had the highest absolute risk of myocardial infarction and atherosclerotic cardiovascular disease and the lowest estimated NNT in 5 years to prevent one event.’

researchers calculated that 80 adults aged 80–100 years — would need to receive a moderate-intensity statin for 5 years to prevent one MI.
and145 adults aged 70–79 years — would need to receive a moderate-intensity statin for 5 years to prevent one MI.
and to prevent just one ASCVD event, the numbers needed to treat were 42 and 88, respectively.

But anytime you read the results you have to say “how did you come up with that number” what were your methods?

In this study they took a sample of people from a large Danish database and these were low risk individuals not on statin therapy. They calculated the number of reduced events by calculating the event rate they expected and dividing it by the number of events during the follow up.

But remember youi have to ask how did you come up with your calculation???

“For these calculations, we assumed 30% and 22% relative risk reduction of myocardial infarction and atherosclerotic cardiovascular disease, respectively, per 1·0 mmol/L reduction in LDL cholesterol in individuals free of atherosclerotic cardiovascular disease, as observed in the Cholesterol Trialist Collaboration meta-analyses.”

THIS IS FRUSTRATING because if you have read the cholesterol trialist you collaboration you know that the individuals in the studies were HONDA they were not low risk individuals. The higher the risk you are the more likely a drug is to work. Think about it like this a statin is more likely to work on someone who is really high risk because they are way more likely to have a MACE. Just like breast cancer chemo therapy is more likely to work on someone who has breast cancer and is even more likely to work if the person is a women.

So in this study they estimated the event rate based on really sick people and then said based on that we can say the likelihood for benefit in these more healthy patients would have a benefit or NNT of 42 or 80 to prevent just one MACE.

NOOOOO you cant take the odds of sick people or people with breast cancer and then say well look how it worked in them so it must work the same way in this population over here.


Do the trial of statins in the elderly or don’t publish the paper