Statin Drugs for Men over 75 Have No Clinical Benefit

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Statin Drugs for Healthy Men over 75 Have No Clinical Benefit by Jeffrey Dach MD

Treat 446 Men to Prevent One Heart Attack

For males over the age of 75 with no prior history of heart disease, you have to treat 446 men with a statin drug to prevent one heart attack. This is called the Number Needed to Treat (NNT), and it is one of the most important statistics in preventive medicine. In plain English, this means that for the vast majority of healthy men over 75, statin drugs provide virtually no meaningful benefit in primary prevention. The absolute risk reduction is so tiny that it barely registers. Yet every day in clinical practice, I see these same men being prescribed statins by well-meaning cardiologists who are relying on relative risk numbers and outdated guidelines rather than the hard data on actual benefit.

Header Image: This illustration is free of all copyright restrictions and available for use and redistribution without permission. Credit to the U.S. Food and Drug Administration is appreciated but not required. 
Source: Statin Risks. Author The U.S. Food and Drug Administration
Link to Original Image on Wikimedia Commons.

Here is a short video of Dr. Aseem Malhotra Discussing the NNT of 446 for Statin Drugs:

2019 Cholesterol Treatment Trialists’ (CTT) Collaboration Meta-analysis

This NNT of 446 number comes directly from the 2019 Cholesterol Treatment Trialists’ (CTT) Collaboration meta-analysis, which pooled individual participant data from 28 randomized controlled trials involving nearly 187,000 people, including more than 14,000 over age 75. In the primary prevention subgroup (no history of vascular disease), the rate ratio for major vascular events per 1 mmol/L LDL reduction in those over 75 was 0.95 (95% CI 0.83–1.07). This means a 5% relative risk reduction which is not statistically significant. When you translate that into absolute terms, the benefit is vanishingly small, hence the NNT of 446 over roughly five years.

How is NNT Calculated?

Over the 5-year study period, only a small percentage of men would have had a major heart event even if they took no statin at all, this is the called the placebo group.

So, the researchers took that small 5% relative risk reduction and applied it to the actual low event rate in the placebo group. The result was an absolute risk reduction that was vanishingly small,something like 0.22%. This means 2.2 fewer events per 1,000 people treated with a statin drug for 5 years.

NNT (Number Needed to Treat) is simply the math that tells you how many people you have to treat to prevent ONE event:

NNT is ONE divided by the Absolute Risk Reduction (0.22%) which gives the result = 446.

Plug in the tiny absolute benefit, and you get NNT = 446.

Translation into plain English:

You would have to give statins to 446 healthy men over 75 for about 5 years to prevent just one heart attack or similar event. For the other 445 men, the statin drug does nothing to prevent a heart attack, yet they were all exposed to the drug’s side effects.

That’s why the NNT of 446 is such a big deal. An NNT of 446 shows that in healthy older men, the absolute benefit is so tiny that it barely exists, even though the relative-risk reduction number (5%) looks slightly encouraging.

Calculate Absolute Risk Reduction with NNT of 446

For an NNT of 446, the Absolute Risk Reduction (ARR) = 1 ÷ 446 ≈ 0.224%. This means for 1,000 people treated over 5 years with a statin drug, only 2.24 cardiac events (heart attacks) are prevented. 

The Statin Disaster

This was discussed in Dr. David Brownstein’s powerful book, The Statin Disaster. David Brownstein is a holistic family physician in Michigan who dismantles the statin hype by showing that statin drugs fail to prevent or treat coronary artery disease for nearly 99 percent of the people who take them. He devotes much of the book to the statistical sleight-of-hand used by the pharmaceutical industry, particularly the Number Needed to Treat. Dr. Brownstein explains that the ideal NNT is 1, meaning every patient treated benefits. With statins, however, the NNT in primary prevention is shockingly high (often in the hundreds or even thousands), meaning vast numbers of healthy people must take the drug for years for a few to see any hypothetical benefit. He calls out the cholesterol-heart disease hypothesis as a failed paradigm and documents the long list of serious side effects, muscle damage, memory loss, diabetes, neurological problems that far outweigh any tiny absolute benefit. Brownstein’s conclusion is blunt: statins should be pulled from the market, and doctors should turn instead to safe, natural therapies.Two widely cited analyses drove this number home and made it part of the national conversation:

Carl Heneghan spelled it out clearly: “In participants over 75 without vascular disease, statins do not appear to reduce major vascular events: NNT 446.”

Nigel Hawkes, writing in the BMJ, highlighted the same data and asked the obvious question about whether mass statin prescribing in the healthy elderly actually saves lives or simply creates patients.

Real Patient Stories That Tell the Story

Let me share a few stories from my own practice that illustrate why this NNT of 446 is so relevant.

Mr. Robert J., age 78, retired engineer, no history of heart attack or stroke, excellent coronary artery calcium score of zero. His cardiologist started him on atorvastatin “just to be safe.” Within six months he developed nagging muscle aches in his thighs, fatigue that he described as “walking through molasses,” and a mild decline in memory that worried his wife. He stopped his statin drug. Within three weeks the muscle pain vanished, energy returned, and his wife said his thinking was sharper. Two years later, still off the drug, he remains active, plays golf twice a week, and has had zero cardiac events. Treating 446 men like Robert to possibly prevent one event simply wasn’t worth it for him.

Mr. Henry K., age 76, former school principal, primary prevention, low risk. He was placed on rosuvastatin by his internist after a routine cholesterol panel. He came to me complaining of weakness climbing stairs and new-onset erectile dysfunction. Labs showed elevated CPK. We discontinued the statin and switched to evidence-based natural approaches, my calcium score prototol, magnesium, CoQ10, Vitamin C, Vitamin K, Aged Garlic, proteolytic Enzymes, Berberine, Mediterranean diet, and optimized thyroid. Two years later he is stronger, sexually active again, and his coronary calcium score remains low. He often tells me, “Doc, I feel like they were trying to turn me into an old man before my time.”

Mr. William T., age 82, healthy, independent, zero CAC score, refused statin therapy five years ago despite his family doctor’s insistence. He is still hiking with his grandchildren, sharp as a tack, and has never had a heart event. His story is the rule, not the exception, for the 445 out of 446 men who would never have had that “prevented” heart attack anyway.

These are not isolated cases. In my twenty-plus years of practicing integrative medicine, I have seen dozens of elderly men harmed by statins with little or no offsetting benefit, exactly what the NNT data and Dr. Brownstein’s analysis predict. The side effects of muscle pain (myopathy), cognitive fog, diabetes risk, and loss of vitality are real and far more common than the tiny absolute benefit in primary prevention.

Landmark Studies and Guidelines Confirm: No Routine Statins for Healthy Men Over 75

Three major, widely cited studies and official guidelines back up exactly what I see in my office every day: for healthy men over 75 with no prior heart disease, the data simply do not support starting a statin drug for primary prevention. The risks outweigh the tiny potential benefit.

The U.S. Preventive Services Task Force (USPSTF) 2022 Recommendation Statement.

In 2022, Dr. Carol M. Mangione reviewed every high-quality study on statins for primary prevention, writing:

The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of initiating a statin for the primary prevention of CVD events and mortality in adults 76 years or older. (7)

What does this mean translated into plain English? This means there insufficient evidence to recommend starting a statin in adults aged 76 or older. In plain language: the experts who set national preventive-care standards looked at the balance of benefits versus harms and concluded there is not enough solid proof that statins prevent heart attacks or save lives in this age group without causing more problems than they solve. They specifically noted that the evidence is too weak to make a routine recommendation one way or the other. (7)

The 2019 Cholesterol Treatment Trialists’ (CTT) Collaboration meta-analysis

This is the largest and most authoritative pooling of statin data ever done by Dr. Jordan Fulcher in 2019. He reviewed patient records from 28 randomized trials involving nearly 187,000 people, including more than 14,000 over age 75. For secondary prevention (i.e. people who already had heart disease), statins clearly worked and lowered events substantially. But for primary prevention in healthy people over 75 with no vascular disease, the result was a rate ratio of 0.95 (95% CI 0.83–1.07) per 1 mmol/L LDL reduction, which is not statistically significant. In everyday terms: the statin produced no reliable reduction in heart attacks, strokes, or other major events. The absolute benefit was so small that you would need to treat 446 healthy older men for five years to prevent just one event. The authors themselves emphasized there is “less direct evidence of benefit” in this primary prevention group. (3)

Third, Dr. Carl Heneghan’s 2019 analysis in BMJ Evidence-Based Medicine took the raw CTT numbers and translated them into the practical terms doctors and patients actually need: absolute effects and Number Needed to Treat. He showed that in participants over 75 without vascular disease, “statins do not appear to reduce major vascular events: NNT 446.” Heneghan stressed that we should look at absolute benefits, not just relative-risk percentages, because that is what tells the real story for healthy older people. His conclusion was blunt: the tiny benefit does not justify routine prescribing when you factor in side effects and quality of life. (1)

What This Means for You

These three landmark sources, the official U.S. government preventive task force, the world’s largest statin meta-analysis, and a leading evidence-based medicine expert, all reach the same conclusion:

for healthy men over age 75, the risk-benefit equation does not favor statin drugs. The default should be no statin unless you already have documented vascular disease (secondary prevention), where the benefit is real and the NNT is dramatically lower.

If your doctor is still pushing a statin “just to be safe,” print out these three references and ask for a discussion based on the actual data. Your heart, and your quality of life, will thank you.

The Harms and Adverse Effects of Statin Drugs. 

Supporting the real-world harms I see every day in my practice are two widely cited studies that document serious adverse effects of statin drugs.

Sattar and colleagues published a collaborative meta-analysis of 13 randomized statin trials in The Lancet (2010). They found that statin therapy was associated with a 9% increased risk of new-onset diabetes (odds ratio 1.09; 95% CI 1.02–1.17). This risk is especially concerning for older men, many of whom already have borderline blood sugar or metabolic issues. The absolute excess is small but real—and it adds up when you are treating hundreds of healthy people for almost no cardiovascular benefit.

The European Atherosclerosis Society Consensus Panel, led by Stroes et al. and published in the European Heart Journal (2015), provided a comprehensive review of statin-associated muscle symptoms (SAMS). The panel confirmed that muscle pain, weakness, and related symptoms are a leading cause of statin discontinuation in clinical practice. These symptoms are far more common than the rare rhabdomyolysis reported in trials, often leading to reduced quality of life, loss of mobility, and poorer adherence—exactly the complaints I hear repeatedly from patients who were started on statins “just in case.”

These two studies, combined with the high NNT in the elderly and Dr. Brownstein’s analysis, make it crystal clear: for most healthy men over 75, the risks of statins far outweigh any hypothetical benefit.

Conclusion: Current guidelines from the USPSTF and others already acknowledge insufficient evidence for routine statin initiation in primary prevention after age 75–76. Print this article for you cardiologist opr primary care doctor.

Articles with related interest:

Calcium Score Paradigm Shift in Cardiology

Coronary Calcium Score Benefits of Aged Garlic

The Art of the Curb Side Cholesterol Consult

Fibrinolytic Enzymes, Nattokinase, Lumbrokinase Prevent and Reverse Atherosckerosis

Calcium Score Determines Who to Treat with Statin Drug

Calcium Score Diabetes and Statin Drugs

The Failure of Cholesterol Lowering Drugs

All previous articles on Heart Disease and Calcium Score

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References

1) Heneghan, Carl. “Absolute Effects of Statins in the Elderly.” BMJ Evidence-Based Medicine, vol. 24, no. 5, 2019, pp. 200–01, https://ebm.bmj.com/content/24/5/200.

2) Hawkes, Nigel. “Could Giving Statins to over 75s Really Save 8000 Lives a Year?” BMJ, vol. 365, 2019, l1779, https://www.bmj.com/content/365/bmj.l1779.full

3) Fulcher, Jordan, et al. (Cholesterol Treatment Trialists’ Collaboration). “Efficacy and safety of statin therapy in older people: a meta-analysis of individual participant data from 28 randomised controlled trials.” The Lancet, vol. 393, no. 10170, 2019, pp. 407–15.

4) Brownstein, David. The Statin Disaster. Medical Alternatives Press, 2015.

5) Sattar, Naveed, et al. “Statins and Risk of Incident Diabetes: A Collaborative Meta-Analysis of Randomised Statin Trials.” The Lancet, vol. 375, no. 9716, 2010, pp. 735–42, https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(09)61965-6/fulltext.

6) Stroes, Erik S., et al. “Statin-Associated Muscle Symptoms: Impact on Statin Therapy—European Atherosclerosis Society Consensus Panel Statement on Assessment, Aetiology and Management.” European Heart Journal, vol. 36, no. 17, 2015, pp. 1012–22, https://academic.oup.com/eurheartj/article/36/17/1012/2465952.

7) Mangione, Carol M., et al. “Statin Use for the Primary Prevention of Cardiovascular Disease in Adults: US Preventive Services Task Force Recommendation Statement.” JAMA, vol. 328, no. 8, 2022, pp. 746–53, https://jamanetwork.com/journals/jama/fullarticle/2795521.)

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Jeffrey Dach MD
7450 Griffin Road, Suite 190
Davie, Fl 33314
954-792-4663
my web site: https://drjeffreydachmd.com/
my personal blog: www.jeffreydachmd.com 
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