Meta-analysisindependent cross-checkabstract checked★ key study I-FAT-110 in-depth review
Lowering LDL cholesterol prevents heart attacks and strokes at all ages
Efficacy and safety of statin therapy in older people: a meta-analysis of individual participant data from 28 randomised controlled trials.
Overview
Cholesterol Treatment Trialists' Collaboration. Lancet 2019 · PMID 30712900 · DOI 10.1016/S0140-6736(18)31942-1
21% fewer major vascular events per 1 mmol/L lower LDL, including older people.
Does the study support the specific claim? No · Methodological quality: high
Plain-language summary
Study explained simply
- What did the researchers want to find out?
Test statins at different ages.
- How was the study done?
IPD meta-analysis of 28 RCTs.
- How many people, animals or samples were studied?
186,854 people.
- What was actually found?
Benefit at all ages.
- How large was the observed effect?
RR 0.79 per mmol/L.
- What do the results mean in everyday life?
High LDL matters even in older age.
- What are the study's limitations?
Drug trials.
- What does it say about Elawady's specific claim?
Contradicts the claim.
- Do the results apply to Germany and Europe?
Universal.
- What can explicitly not be concluded from this study?
Cannot directly test dietary cholesterol.
Scientific in-depth review
1. Full reference
- Authors
- Cholesterol Treatment Trialists' Collaboration
- Journal
- Lancet
- Year
- 2019
- Identifier
- PMID 30712900 DOI 10.1016/S0140-6736(18)31942-1
- Verification
- verified – PubMed efetch 2026-10-26
- Retracted
- no
- Corrections
- none
- Extent checked
- abstract only
- Conflicts of interest and funding
Australian NHMRC, NIHR Oxford BRC, UK MRC, British Heart Foundation.
2. Research question
Does LDL lowering with statins work at older ages?
3. Study design and population
- Study design
- Meta-analysis – Individual-participant-data meta-analysis of 28 large statin RCTs
- Population
186,854 trial participants; 14,483 aged >75
- Country
Multinational
- Period
median 4.9 y
- Sample size
186,854
- Inclusion and exclusion criteria
Trials >=1000 participants, >=2 y
4. Methods and endpoints
- Exposure / intervention
Statin or more intensive statin
- Comparator
Control or less intensive
- Endpoints
Major vascular events, cause-specific mortality, cancer
- Statistical methods
RR per 1.0 mmol/L LDL reduction; trend tests across six age groups
5. Actual results
- Results
Major vascular events RR 0.79 (0.77-0.81) per 1.0 mmol/L LDL-C reduction, significant in all age groups; major coronary events 0.76 (0.73-0.79); stroke 0.84 (0.80-0.89); vascular mortality 0.88 (0.85-0.91). No effect on non-vascular mortality, cancer death or incidence at any age. Less direct evidence for >75 y without vascular disease.
- Absolute risks
not reported
- Authors' conclusion
Statin therapy produces significant reductions in major vascular events irrespective of age.
6. Strengths
- IPD
- Randomised
- Large
7. Weaknesses
- Drug trials (LDL lowering by statins, not diet)
- Fewer data >75 without CVD
8. Risk of bias
- Orienting tool
- AMSTAR 2
- Type of assessment
- simplified assessment (abstract only)
- Full formal assessment
- no
- Overall risk of bias
- low
- Rationale
Gold-standard IPD.
9. Assessment of the statistical interpretation
Per-mmol/L proportional effects; precise.
10. Relevance to the specific claim
Randomised evidence that lowering LDL cholesterol prevents vascular events in all age groups, including older people where cohort studies show inverse associations; contradicts 'cholesterol is not your enemy' and 'arteries cannot be blocked by fat'.
11. Independent contrary findings
I-FAT-109 (observational).
12. Transferability to Germany and Europe
Universal.
13. Overall methodological judgement
High-certainty contradicting evidence.
| Multidimensional assessment | |
|---|---|
| Authenticity of the source | verified |
| Methodological quality | high |
| Risk of bias | low |
| Precision of results | high |
| Directness | indirect |
| Reproducibility | replicated |
| Consistency with the overall evidence | consistent |
| Regional transferability | moderate |
| Adequacy of the interpretation (by the archive) | not applicable |
14. Open questions
Primary prevention >75.
15. Linked fact checks
- Cholesterol is not your enemy: when insulin falls, the liver produces cholesterol not because it is harmful but because it is the raw material for vitamin D, sex hormones, cortisol and bile salts. – Studies contradicting or limiting the claim
- Blood contains no fat (everything in plasma is water-soluble), so it is impossible for arteries to be blocked by fat. – Studies contradicting or limiting the claim