DEAR DR ROACH: You seem to promote statins. How about statins for older people? A recent study from 2017 that appeared to be peer reviewed and well done found “no benefit was found when pravastatin was given for primary prevention to older adults with moderate hyperlipidemia and hypertension, and a nonsignificant direction toward increased all-cause mortality with pravastatin was observed among adults 75 years and older.” Is this a significant result? — R.B.R.
ANSWER: I do recommend statin drugs for people at a higher risk for heart disease and stroke, but only after a comprehensive look at all of their risk factors. Often, the risk can be lowered by changing lifestyle, especially diet and exercise. Sometimes the risk can be lowered enough that statins are no longer necessary.
Older people had not been the subject of much study until fairly recently. On the one hand, we don’t want to treat people without a good reason to expect that the benefits outweigh the risks. On the other hand, older people have a higher risk of developing vascular disease and its complications.
The 2017 study you quote has been upended by more-recent studies. A 2019 review of all available trials showed that older adults with known cardiovascular disease (blockages in arteries) had a large benefit in reduction of heart attack, stroke and need for procedures such as bypass surgery. A 2020 study on veterans with an average age of 81 who did not have heart blockages showed that starting a statin in this older group reduced overall death rates by about 25%. Looking at it another way, about 23 people per thousand per year died from cardiovascular causes on a statin, while 26 people per thousand per year died from cardiovascular causes if they did not take a statin. This study was not a clinical trial. It just looked at whether a person’s doctor put them on a statin at an older age.
The higher a person’s risk of heart disease, the more value there is to taking a statin. Recent evidence confirms that this remains true even for people over 75. However, the costs of taking a statin — including the financial cost (much lower than it used to be now many drugs are available as generics), side effects and potential drug interactions — need to be considered.
DR. ROACH WRITES: A recent column on trigger finger resulted in a slew of letters, and once again, I learned some new and useful information from my readers. Several readers found that keeping their hands in hot water (please, not hot enough to burn) and doing some hand exercises underwater was enough to treat their condition effectively without shots or surgery. Some people had relief with physical therapy alone.
A family physician (Dr. S.B.) noted that the reader was planning on discussing his condition at his annual wellness visit, and wrote to remind me that the annual wellness visit is separate from a visit to discuss medical problems. Trying to do both a problem-based visit and a wellness check at the same time can lead to billing complications. He wrote this: “I have found it best to be very, very clear at the time the appointment is made that only preventive services can be addressed. For instance, ‘Can we schedule you for a separate appointment for that thumb pain?'” He advised me to “Please encourage patients to schedule appointments for their problems when the problem comes up and not save them up for their annual exam.”
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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.
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