The relationship between lipid-lowering medication and non-healthy status
Authors: Yangyan Wei, Wenjie Zhu, Kai Yang, Zhengdong Hua
Journal: The Lancet Healthy Longevity (2024)

The Article by Tuija M Mikkola and colleagues1Mikkola TM Kautiainen H von Bonsdorff MB et al.Healthy ageing from birth to age 84 years in the Helsinki Birth Cohort Study, Finland: a longitudinal study.Lancet Healthy Longev. 2023; 4: e499-e507Summary Full Text Full Text PDF PubMed Scopus (2) Google Scholar and the accompanying Comment by Wang and colleages2Wang Y Zhao Y Cohort studies have great potential in healthy ageing research.Lancet Healthy Longev. 2023; 4: e450-e451Summary Full Text Full Text PDF PubMed Scopus (0) Google Scholar reported that the probability of healthy survival in the Helsinki Birth Cohort Study was less than 50% from age 65 years. Healthy ageing is influenced by several clinical factors. This study found that age, nutrition, former smoker status, and use of lipid-lowering medication in late midlife (age 62 years) were associated with healthy ageing. Mikkola and colleagues suggested that the promotion of healthy ageing should take a life course approach. However, one of the conclusions of their study should be considered with caution, which is that healthy participants were less likely to use lipid-lowering medication than non-healthy participants. The use of lipid-lowering drugs was significantly lower in the healthy group than in the non-healthy group (11·3% vs 16·7%, age-adjusted odds ratio=0·6). This result does not seem to be consistent with the protective effect of lipid-lowering drugs on patients with cardiovascular and cerebrovascular disease, which could be for three reasons. First, subgroup analysis was not conducted in Mikkola and colleagues' study. In patients with coronary heart disease and stroke, lipid-lowering therapy is essential. However, the definition of non-healthy ageing not only included other heart diseases and stroke, but also contained other common chronic diseases, such as cancer, chronic lung diseases, and cognitive dysfunction. Therefore, cardiocerebrovascular diseases, as important confounders, should have been adjusted before a conclusion was drawn about the relationship between lipid-lowering drugs and non-healthy status. Second, after using lipid-lowering medicine, the mortality of patients who had major adverse cardiovascular or cerebrovascular events (MACCEs) was substantially reduced.3Chou R Cantor A Dana T et al.Statin use for the primary prevention of cardiovascular disease in adults: updated evidence report and systematic review for the US Preventive Services Task Force.JAMA. 2022; 328: 754-771Crossref PubMed Scopus (32) Google Scholar, 4Dalli LL Kim J Cadilhac DA et al.Greater adherence to secondary prevention medications improves survival after stroke or transient ischemic attack: a linked registry study.Stroke. 2021; 52: 3569-3577Crossref PubMed Scopus (15) Google Scholar, 5Milionis H Ntaios G Korompoki E Vemmos K Michel P Statin-based therapy for primary and secondary prevention of ischemic stroke: a meta-analysis and critical overview.Int J Stroke. 2020; 15: 377-384Crossref PubMed Scopus (0) Google Scholar Healthy ageing in people who had taken lipid-lowering drugs in 2001–04 had a higher survival rate after MACCEs onset than healthy non-users, and they were subsequently included in the non-healthy group during a follow-up in 2017–18. By contrast, healthy participants who did not take lipid-lowering drugs would normally have a higher mortality rate when they had MACCEs. At the same time, participants in the non-healthy group who used lipid-lowering drugs also had higher survival rates when MACCEs occurred than non-healthy non-users. Therefore, this protective effect might hae led researchers to overestimate the correlation between lipid-lowering drugs and non-health conditions. Finally, as seen in table 4 of the original Article, participants were grouped according to their health status, and to retrospectively explore the relationship between baseline characteristics and health status. Bias in case-control studies is unavoidable, but to further show the relationship between lipid-lowering drugs and health status in older adults (age >65 years), a special cohort study should be designed. We declare no competing interests. Healthy ageing from birth to age 84 years in the Helsinki Birth Cohort Study, Finland: a longitudinal studyThe probability of healthy survival, as the upper limit for healthy ageing, was less than 50% from age 65 years. The probability of healthy survival and healthy ageing was influenced by several factors across the life course. Promotion of healthy ageing needs to take a life course approach. Full-Text PDF Open Access