Statins and fibrates are two classes of medications commonly prescribed to people with high cholesterol.

Statins work by preventing the formation of cholesterol. They primarily reduce levels of LDL (bad) cholesterol, but also reduce harmful triglycerides and raise HDL (good) cholesterol.

Fibrates main function is to lower triglycerides (a form of fat in the blood), but they also lower LDL and may increase HDL cholesterol.

These medications are usually prescribed to people who are at a higher risk for a heart attack or stroke, or who have had a previous cardiovascular event or diagnosis of a cardiovascular disease.

Current American Heart Association/American College of Cardiology (AHA/ACC) guidelines for cholesterol management do not recommend statins in people over 75 years old without history of vascular events. One reason for this is drug interaction—older people generally take multiple medications, which increases the risk of adverse effects.

That doesn't mean statins are not prescribed. In fact, statins are frequently prescribed to those over 75 without a history of heart disease.

And a recent French study suggests that people without a history of cardiovascular events or risk factors who take statins or fibrates have a 30% lower risk of stroke.

About the Study

Researchers analyzed over 9,000 people from the Three-City study, a prospective study of randomly selected people ages 65 or older living in three cities in France: Bordeaux, Dijon, and Montpelier. The study’s main goal is to determine the association between vascular diseases and risk of dementia.

Among the 9,294 people enrolled, 1,439 were not eligible for this study because they had a history of coronary heart disease, stroke, or both at the beginning of the study. Those who were taking lipid-lowering drugs other than statins or fibrates were also excluded. The remaining 7,484 participants were followed for a period of 9 years.

While more research is needed to confirm findings, if replicated, the study results suggest that lipid-lowering drugs might be considered for the prevention of stroke in older populations.

Lowering Stroke Risk: Lifestyle or Lipid-Lowering Drugs?

“This study of French persons taking statins or fibrates is an observational study. While fibrates may have a benefit in reduction of stroke, differences in the health of persons who happen to be taking or not taking a statin or fibrate could have provided the result it did. Thus, the relationship between taking statins or fibrates may be associative but not causal,” says Gregory Thomas, MD, Medical Director, MemorialCare Heart & Vascular Institute, Long Beach Memorial Medical Center, California.

Thomas follows the AHA/ACC guidelines on coronary artery disease prevention, in which a health care provider bases treatment decisions on an individual patient’s characteristics, lifestyle, and family history of heart disease.

However, the study’s limitations may prove to the best takeaway for your health: The study’s participants, while part of the general population, differed from the rest of the French population in that they had higher education and economic status, better cognitive functioning, and they lived a healthy lifestyle (dietary habits) which may have contributed to reducing their vascular risk.

“There is increasing evidence that regular physical exercise substantially decreases the risk of cognitive decline seen with aging,” adds Thomas. “Regular exercise, which in older individuals need only to be as vigorous as walking at a normal pace, decreases the risk of coronary artery disease and boosts brain health. If one wants to stay heart and brain healthy, a daily walk may be just what the doctor ordered.”

Gregory S. Thomas, MD, MPH, FACC, FASNC, Medical Director at MemorialCare Heart & Vascular Institute, reviewed this article.


Alpérovitch, Annick, et al. “Primary prevention with lipid lowering drugs and long term risk of vascular events in older people: population based cohort study.” BMJ 2015; 350.

Gregory S. Thomas, MD, MPH, FACC, FASNC. Medical Director, MemorialCare Heart & Vascular Institute, Long Beach Memorial Medical Center, Miller Children's Hospital of Long Beach, Clinical Professor & Director of Nuclear Cardiology Education, University of California, Irvine. Email message to author, July 23, 2015.

Drug Therapy for Cholesterol. American Heart Association. May 15, 2014.

Stone, Neil J, et al. “ACC/AHA Guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults” J Am Coll Cardiol. 2014;63(25_PA):. doi:10.1016/j.jacc.2013.11.002.