Most over-70s should be prescribed statins, concludes UK modelling study

10th October 2024

Statins are cost effective and improve health outcomes for the over-70s with or without previous cardiovascular disease, a large UK modelling study has concluded.

The findings support their routine use in most people in this age group, the team from the University of Oxford concluded.

With an ageing population, the over-70s age group now makes up around 30% of people over the age of 40 in the UK, yet despite their increased cardiovascular risk, statins use in this older group is lower, the researchers noted in the journal Heart.

The study used an up-to-date cardiovascular disease model developed from UK populations, including a Biobank cohort, which included information on statins safety and effectiveness in older people.

Projected cardiovascular risk figures including on survival, quality-adjusted life years (QALYs) and healthcare costs of statins use were calculated in 5,103 people with previous cardiovascular disease and in 15,019 without.

Use of statins was found to be cost-effective with the cost per QALY gained below £3,502 for standard therapy and below £11,778 for higher intensity therapy.

The team did note that there was a larger degree of uncertainty among older people without previous cardiovascular disease where risk reductions were substantially smaller.

There are two ongoing statin trials in older people without cardiovascular disease which ‘will add valuable data’ particularly in those over the age of 75 years, the researchers said, but added that their findings were robust enough to recommend statin treatment in this age group now.

Lead study author Borislava Mihaylova, an associate professor at Oxford Population Health, said: ‘Lifetime statin treatment increased quality-of-life-adjusted survival in older men and women and, at UK cost of generic statins, was highly cost-effective for all, irrespective of their CVD history or LDL-C level.

‘Higher intensity statin therapy was the strategy likely to bring the highest health benefits cost-effectively, although standard statin regimens would achieve most of these benefits.’

She continued: ‘While further randomised evidence will be helpful, the robustness of these findings indicates that older people are likely to benefit cost-effectively from statin therapy and should be considered for treatment.’

Dr Gavin Stewart, reader in interdisciplinary evidence synthesis at Newcastle University, said: ‘The finding that statins are cost effective and linked to better health outcomes in older people is likely to be robust. 

‘It is based on sound analysis and interpretation of well conducted individual patient data meta-analysis and modelling. 

‘Notwithstanding the uncertainty associated with modelling observational data, it appears that statins are likely to improve health in average older people.’

A version of this article was originally published by our sister publication Pulse.

Sudden cardiac arrest in exercising older adults not related to disease burden

1st February 2023

The incidence of sudden cardiac arrest (SCA) among older adults during sporting activities is low and not related to either co-morbidities or cardiovascular risk factors in comparison to non-exercising sudden arrests according to the findings of a prospective study by US researchers.

Sudden cardiac death is due to a cardiovascular cause and occurs within one hour of symptom onset. While possible triggers include factors such as vigorous exercise, interestingly, habitual vigorous exercise appears to reduce the risk of such deaths.

In other work focusing on middle-aged people engaging in sporting activities, it was has found that the level of sudden cardiac arrests is relatively low illustrating the high-benefit, low-risk of sporting activities in such individuals.

However, there is lack of studies examining the incidence of SCA among older adults who participate in sporting activities.

In the current study, researchers turned to two large prospective US studies to more closely examine the incidence of SCA among adults 65 years of age and older.

They identified information on the presence of any potential warning signs prior to the arrest, the circumstances under which the arrest occurred and collected detailed information on the patient’s clinical history.

They defined a SCA as occurring either during or within one hour of stopping a sporting activity and compared the incidence to sudden arrests that occurred among older adults but who were not exercising.

Sudden cardiac arrest during sporting activity

Data were available for 1.85 million individuals and there were a total of 4,078 SCAs among those aged 65 and older (1.9%) and of these, 77 occurred during exercise, with 91% of cases in men, mainly during cycling, gym activity and running.

When comparing SCAs among those who exercised to non-exercising controls, individuals whose arrest happened while exercising had a significantly lower burden of cardiovascular risk factors such as hypertension (e.g., 57.8% vs 80.1%), diabetes or obesity (p = 0.03) and co-morbidities such as asthma or COPD (p < 0.005).

Interestingly, only 26% of those with a SCA during exercise had prior warning signs, mainly chest pain (55%) in the 24 hours before the arrest. Moreover, survival was higher among the exercise group compared to the non-exercising group (43.8% vs 11.1%).

The authors concluded that the risk of a sudden cardiac arrest was uncommon among older adults and probably outweighed by the benefits of exercise.

Citation
Holmstrom L et al. Sudden Cardiac Arrest During Sports Activity in Older Adults. JACC Clin. Electrophysiol 2023.

Increased smartphone-recorded daily steps assessed over a two-year period associated with a beneficial effect on CV risk factors

12th August 2022

Greater smartphone-recorded daily steps over a 2-year period led to reductions in cardiovascular risk but which varied in men and women

Increased smartphone-recorded daily steps assessed over a two-year period are associated with a beneficial effect on cardiovascular risk factors, although not all of these positive effects are seen in both sexes according to a large cohort study by Japanese researchers.

There is a good deal of evidence indicating that a higher number of daily steps is associated with a reduced risk of all-cause mortality. In fact, a 2020 systematic review concluded that the evidence from longitudinal data consistently demonstrated that walking an additional 1000 steps per day can help lower the risk of all-cause and cardiovascular mortality.

However, an important limitation from virtually all of the studies included in the review is that the daily step-count was recorded at a single point in time (usually at baseline) in the majority of cases, although some studies did incorporate a second measurement. Smartphone-recorded daily steps have been suggested to be of practical use to individuals, clinicians, and researchers for monitoring physical activity.

Moreover, the use of smartphone-recorded daily steps has been suggested in the 2018 US physical activity guideline to enable self-monitoring, deliver messages, and provide support, all of which are helpful in promoting regular physical activity.

As a result, in the present study, the Japanese researchers made use of smartphone-recorded consecutive daily steps over a period of 2 years to explore if there was an associated change in cardiovascular disease-related measures.

To examine any link, the team used information held within a Japanese national health check-up, a national health insurance claims and a commercial mobile phone app database (used by workers who belonged to work-based health insurance schemes and which provided daily step information). The primary exposure of interest was the smartphone-recorded daily step count between two annual healthcare checks which were between 24 and 35 months apart.

The primary outcomes were changes in markers at follow-up health checks in comparison to baseline. The researchers included several measures including weight, body mass index (BMI), systolic and diastolic blood pressure, HDL and LDL cholesterol, triglycerides, fasting glucose levels and HbA1c (%). In addition, demographic, lifestyle and co-morbidity data were also collected and adjusted for in their analysis.

Smartphone-recorded daily steps and cardiovascular outcomes

A total of 15,708 participants with a mean age of 44.1 years (23.5% female) were included in the study and daily step information was available for a period of two years. Overall, the median number of daily steps was higher for men than women (6674 vs 5027).

For most changes, there was an almost linear and inverse relationship between changes in weight or BMI and the number of steps but also apparent differences between men and women. For example, in men, each additional 1000 steps/day was associated with a 0.32 loss in weight, -0.11 reduction in BMI and 0.37 lowering in waist. In women, however, the same inverse association was only evident above 5000 steps/day (0.18 loss in weight).

Similarly, the inverse relationship remained for systolic and diastolic blood pressure but only in men, with, for instance, a reduction in systolic pressure of 0.33mmHg for each additional 1000 steps/day. For lipid changes, both HDL and triglycerides were reduced with increased steps/day in both sexes although significant changes in LDL were only apparent for men.

Finally, while improvements in fasting glucose levels occurred in both sexes, there were similar effects on fasting glucose levels in both sexes though a significant negative association was observed for changes in % HbA1c but only for women.

The authors concluded that overall increases in smartphone-recorded daily steps was associated with positive changes in several cardiovascular risk factors although there were differences between the sexes for some factors. They added that smartphone-recorded steps may be a useful clinical tool to gauge cardiovascular health.

Citation
Hamaya R et al. Association of Smartphone‐Recorded Steps Over Years and Change in Cardiovascular Risk Factors Among Working‐Age Adults J Am Heart Assoc 2022