Efficacy and safety of statin therapy in hypertensive elderly patients without dyslipidemia: a systematic review and meta-analysis

<p><strong>Background: </strong>The role of statins for primary cardiovascular prevention in older adults with hypertension but without established cardiovascular disease remains uncertain. This systematic review and meta-analysis evaluated the effectiveness and safety of statin therapy in this population.</p> <p><strong>Methods:</strong> PubMed, Scopus, Web of Science, Cochrane CENTRAL, and Google Scholar were searched for English-language studies published between 2005 and 2025. Eligible studies included adults aged &ge;60 years with hypertension and no established cardiovascular disease who received statin therapy compared with no statin, placebo, or usual care. Randomized controlled trials and observational studies were included. Hazard ratios (HRs) were used as the primary effect measure for time-to-event outcomes, while risk ratios (RRs) from crude event counts were analyzed separately. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool or Newcastle-Ottawa Scale, and certainty of evidence was evaluated using GRADE.</p> <p><strong>Results: </strong>Four studies involving 17,173 participants were included, of whom 16,709 contributed to cardiovascular outcome analyses. Statin therapy was associated with lower risks of major adverse cardiovascular events (HR 0.78, 95% CI 0.69-0.88), myocardial infarction (HR 0.64, 95% CI 0.48-0.87), and stroke (HR 0.78, 95% CI 0.63-0.97), with no detectable heterogeneity for these outcomes. No significant association was observed with cardiovascular mortality (HR 0.92, 95% CI 0.71-1.19). The pooled random-effects estimate for all-cause mortality was also not statistically significant (HR 0.86, 95% CI 0.70-1.06); the randomized estimate was null (HR 0.98, 95% CI 0.77-1.23), whereas the observational estimate showed lower mortality (HR 0.79, 95% CI 0.68-0.93). Safety data were limited but showed no clear increase in muscle symptoms, marked transaminase elevation, serious adverse events, or new-onset diabetes; no cases of rhabdomyolysis were reported. The certainty of evidence was low for non-fatal cardiovascular outcomes and very low for mortality and safety outcomes.</p> <p><strong>Conclusion:</strong> Statin therapy was associated with fewer major cardiovascular events, myocardial infarctions, and strokes among older adults with hypertension without established cardiovascular disease, based on one post-hoc randomized subgroup analysis and one observational cohort. However, evidence for mortality benefit remains uncertain: the randomized estimate for all-cause mortality was null and the apparent reduction came from the observational study alone. Mean baseline LDL cholesterol was 133 to 138 mg/dL, so the findings should not be generalized to strictly normolipidaemic patients or to low-dose statin therapy.</p>