title: [Benefits and risks for primary prevention with statins in the elderly].
abstract: BACKGROUND
  Statins in primary prevention before 75 years old reduce cardiovascular events from 20 to 30% and mortality from 10% with acceptable side effects. We investigated whether these results persisted for patients aged 75 and older taking statin.
  
  
  METHODS
  Methodic review of large randomized clinical trials and meta-analyzes that included patients 75 years and older treated with statins in primary prevention.
  
  
  RESULTS
  Since the 1990s, a score of randomized controlled trials studying statins versus placebo in primary prevention were published and studied in meta-analyses. Exclusion criteria, including persons older than 70 years, are often restrictive. The impact on all-cause mortality in the four main studies and meta-analyses in over 75 years has not been demonstrated. On the other hand, a recent meta-analyses of observational studies including subjects between 70 and 89 years treated with statins found that low total cholesterol was associated with a moderate decrease in cardiovascular mortality, with no decrease in all-cause mortality. Moreover, in a common context of comorbidities in this age group, statins may be responsible for many adverse effects, drug interactions and impaired quality of life.
  
  
  CONCLUSIONS
  Given the lack of formal evidence of effectiveness in terms of all-cause mortality and a high level of adverse effects, the benefit/risk of primary prevention with statins is not established in the elderly. The economic weight of statin prescriptions and their possible impact on quality of life justify an economic analysis of discontinuing statin therapy for people 75 years and older.
authors.affiliation: Université de Bordeaux, département de médecine générale, 146, rue Léo-Saignat, 33076 Bordeaux cedex, France. Electronic address: jean-philippe.joseph@u-bordeaux.fr.
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Joseph
authors.affiliation: Université de Bordeaux, département de médecine générale, 146, rue Léo-Saignat, 33076 Bordeaux cedex, France.
authors.forename: Mélanie
authors.initials: M
authors.lastname: Afonso
authors.affiliation: CHU de Bordeaux, service de pharmacologie médicale, place Amélie-Raba-Léon, 33076 Bordeaux cedex, France.
authors.forename: Driss
authors.initials: D
authors.lastname: Berdaï
authors.affiliation: CHU de Bordeaux, hôpital Haut-Lévèque, département de gériatrie, 33604 Pessac cedex, France.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Salles
authors.affiliation: CHU de Bordeaux, USMR, place Amélie-Raba-Léon, 33076 Bordeaux cedex, France.
authors.forename: Antoine
authors.initials: A
authors.lastname: Bénard
authors.affiliation: Université de Bordeaux, département de médecine générale, 146, rue Léo-Saignat, 33076 Bordeaux cedex, France.
authors.forename: Bernard
authors.initials: B
authors.lastname: Gay
authors.affiliation: CHU de Bordeaux, hôpital Saint-André, service de médecine interne et maladies infectieuses, 33000 Bordeaux, France.
authors.forename: Fabrice
authors.initials: F
authors.lastname: Bonnet
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000401:mortality / Q000517:prevention & control*; D002423:Cause of Death; D004347:Drug Interactions; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use*; D011322:Primary Prevention; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D016019:Survival Analysis
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors