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statins in the elderly

Clinical significance: - harms exceed small benefit for primary prevention in elderly > 75 years of age [1] - evidence is insufficient to weigh benefits vs harms in elderly > 75 years of age [2,3,4] - discontinuation of statin associated with 33% increased risk of hospitalization for cardiovascular event in 75-year-old treated for primary prevention [5] (French study) - in contrast, a controversy in 2013 in France led to discontinuation of statin use for primary prevention by 50% & all-cause mortality & cardiovascular mortality declined rather than increased [6] - LDL cholesterol not associated cardiovascular disease in elderly > 75 years [7] - low-moderate intensity statins initiated in elderly >= 75 years associated with greater mean reduction in LDL cholesterol than in younger patients 2.62% for primary prevention, 2.3% for secondary prevention [8] - for atorvastation 40 mg, mean reduction in LDL cholesterol only 1.4% greater in elderly >= 75 years (not statistically significant) [8] - for atorvastation 80 mg, mean reduction in LDL cholesterol 0.6% greater in younger adults than elderly [8] - there is large patient-patient variability in LDL cholesterol response to statins [8]

Interactions

drug adverse effects of HMG CoA reductase inhibitors monitor with HMG CoA reductase inhibitors (statins)

Related

statin deprescribing Statins & the risk of dementia

General

HMG CoA reductase inhibitor (statin)

References

  1. Odden MC et al Cost-Effectiveness and Population Impact of Statins for Primary Prevention in Adults Aged 75 Years or Older in the United States. Ann Intern Med. 2015;162(8):533-541 PMID: 25894023 http://annals.org/article.aspx?articleid=2275384 - Rich MW Cost-Effectiveness of Statins in Older Adults: Further Evidence That Less Is More. Ann Intern Med. 2015;162(8):590-591 PMID: 25894030 http://annals.org/article.aspx?articleid=2275394
  2. US Preventive Services Task Force Statin Use for the Primary Prevention of Cardiovascular Disease in Adults. US Preventive Services Task Force Recommendation Statement. JAMA. 2016;316(19):1997-2007. PMID: 27838723 http://jamanetwork.com/journals/jama/fullarticle/2584058 - Chou R, Dana T, Blazina I et al Statins for Prevention of Cardiovascular Disease in Adults. Evidence Report and Systematic Review for the US Preventive Services Task Force. PMID: 27838722 http://jamanetwork.com/journals/jama/fullarticle/2584058 - Greenland P, Bonow RO. Interpretation and use of another statin guideline. JAMA 2016 Nov 15; 316:1977. PMID: 27838703 - Redberg RF, Katz MH. Statins for primary prevention: The debate is intense, but the data are weak. JAMA 2016 Nov 15; 316:1979. PMID: 27838702 - Navar AM, Peterson ED. Evolving approaches for statins in primary prevention: Progress, but questions remain. JAMA 2016 Nov 15; 316:1981 PMID: 27838704
  3. US Preventive Services Task Force Statin Use for the Primary Prevention of Cardiovascular Disease in Adults. US Preventive Services Task Force Recommendation Statement. JAMA. 2022;328(8):746-753 PMID: 35997723 https://jamanetwork.com/journals/jama/fullarticle/2795521 - Habib AR, Katz MH, Redberg RF. Statins for Primary Cardiovascular Disease PreventionTime to Curb Our Enthusiasm. JAMA Intern Med. 2022;182(10):1021-1024. PMID: 35997985 https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2795661
  4. Skolnik N Reexamining Recommendations for Treatment of Hypercholesterolemia in Older Adults. JAMA. Published online March 11, 2019 PMID: 30855637 https://jamanetwork.com/journals/jama/fullarticle/2728377
  5. Giral P, Neumann A, Weill A, Coste J. Cardiovascular effect of discontinuing statins for primary prevention at the age of 75 years: a nationwide population-based cohort study in France Euro Heart J. [published online July 31, 2019]. PMID: 31362307
  6. Gurwitz JH, Go AS, Fortmann SP. Statins for Primary Prevention in Older Adults: Uncertainty and the Need for More Evidence. JAMA. 2016 Nov 15;316(19):1971-1972. No abstract available. PMID: 27838724 Free PMC Article
  7. Nanna MG, Navar AM, Wojdyla D, Peterson ED. The association between low-density lipoprotein cholesterol and incident atherosclerotic cardiovascular disease in older adults: Results from the National Institutes of Health pooled cohorts. J Am Geriatr Soc 2019 Dec; 67:2560 PMID: 31411740 https://onlinelibrary.wiley.com/doi/abs/10.1111/jgs.16123
  8. Corn G, Melbye M, Hlatky MA, Wohlfahrt J, Lund M. Association Between Age and Low-Density Lipoprotein Cholesterol Response to Statins. A Danish Nationwide Cohort Study. Ann Intern Med 2023 Aug; 176:1017 PMID: 37523692