Don’t routinely prescribe lipid-lowering medications in people aged 80 years and over especially for primary prevention of cardiovascular disease; don’t use statins in elderly patients with severe frailty
Given the limited high quality evidence and documented statin adverse effects (including myopathy, medication interactions and new onset diabetes) main cardiologic guidelines do not recommend statin therapy for primary prevention in people aged 80 years and over. The oldest ages (> 85 years) are probably not to be considered for cholesterol reduction in primary prevention, since substantial evidence indicates that higher total and non-HDL-C may be associated with a lower mortality. Treating for primary prevention geriatric population should be discouraged due to decreased life expectancy, increased co-morbidities, and increased risk of adverse reactions. Statins are probably not necessary for secondary prevention in patients who are severely frail.
Sources
1. AMDA The Society for Post-Acute and Long-Term Care Medicine. Ten Things Physicians and Patients Should Question. https://paltc.org/choosing-wisely
2. Ruscica M, Macchi C, Pavanello C, Corsini A et al. Appropriateness of statin prescription in the elderly. Eur J Intern Med. 2018Apr;50:33-40.
3. Mallery LH, Moorhouse P, McLean Veysey P et al. Severely frail elderly patients do not need lipid-lowering drugs. Cleve Clin J Med. 2017 Feb;84(2):131-142.
4. Leya M, Stone NJ. Statin Prescribing in the Elderly: Special Considerations. Curr Atheroscler Rep. 2017 Oct 11;19(11):47
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PDFAttention. Please note that these items are provided only for information and are not intended as a substitute for consultation with a clinician. Patients with any specific questions about the items on this list or their individual situation should consult their clinician.
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