If you are over 75 and have not have a cardiovascular event, you face a choice— take a statin or not.
A new French study claims to provide information. 1100 75 yo + people on a statin, randomized to stop or not. The trial met non-inferiority. (the margin was insanely large) Some argue, these data mean it is ok to stop. Others say this study is useless.
Unfortunately, the entire field is poorly conceived. The last thing we need is another statins trial in the very elderly. Allow me to explain…
If you are 77, 82, or 90 and haven’t had a cardiovascular event, you are one of three people.
You don’t care about marginal differences, and will never take a statin.
You don’t mind taking meds, and will happily swallow for some possible marginal gain.
You are waiting for a new trial to inform your choice.
There is almost no one left in the third bucket. It is very likely that taking a statin has some small reduction in MI— as even this study also finds 2.1→1.4 %. At worst, the overall impact is really rather marginal.
You could run a 10,000,000 person randomized trial, and you will spend 10 billion dollars in taxpayer money, and you won’t change the mind of the first and second groups. Some people will tell you to go to hell, and some love taking medicine.
Randomized trials are great when the upside and downside are not well known, and the trial can provide estimates that change our minds. Oseltamivir in critically ill flu pts— great trial— increased mortality is a reason not to do it. Chemotherapy in an early stage cancer pt— great trial— a toxic drug which may or may not help.
Statins in a very old person. Not much benefit, not much harm. Preference sensitive. Do whatever you want.
But if you do run a randomized trial— please don’t make it non-inferiority and pick a margin like this
This margin is ludicrous. You could randomize 75 year olds to discontinue all medical care, and only pray to a god made from coconut shells and achieve this margin. Anyone who thinks this trial is a good use of money is mistaken.
My answer is: I won’t be taking a statin at 75 (if event free to that date). If you want to take one, do it. Just don’t waste time and money with uninformative trials. Better to make it over the counter.
Oh, too late….. 90 million
It’s ludicrous that so much money has been made providing so many people so little benefit.
Thank you Sir for all your efforts looking out for your fellow humans and their welfare , it comes from a good place , long may you continue , there are many , many more silent appreciative people like myself i believe.