The most recent international guidelines indicate lipid-lowering therapy in subjects over 70 years of age mainly for secondary prevention; it should be considered in primary prevention, albeit with a low level of evidence, only for patients with very high cardiovascular risk, with a view to individualizing the therapeutic choice in accordance with the performance status, comorbidities and expectations of the individual patient. In spite of that, a third of patients older than 75 years still assume lipid-lowering therapy. Moreover, in subjects older than 80 years the decision of physicians should be guided mainly by life expectancy, any terminal comorbidities (such as advanced dementia) and frailty. These factors predominantly affect adherence to therapy and expose patients to adverse events (myopathies, new onset diabetes, drug interactions). Given a limited life expectancy, i.e. less than 10 years, the start of statin therapy is not supported by scientific evidence and its continuation is questionable.

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