Statins Are Likely Helpful In the Very Elderly
Should we be using statins for primary prevention in our very old patients? For many years the answer was generally “no” on the basis of a lack of evidence. Patients in their 80s often were not included in clinical trials. The much used American Heart Association risk calculator stops at age 79. Given the prevalence of coronary artery disease in patients as they reach their 80s, wouldn’t primary prevention really be secondary prevention? Xu and colleagues in a recent study compared outcomes for patients who were treated with statins for primary prevention with a group who were not. In the patients aged 75-84 there was a risk reduction for major cardiovascular events of 1.2% over 5 years, and for those 85 and older the risk reduction was 4.4%. Importantly, there were no significantly increased risks for myopathies and liver dysfunction in either age group.
Dr. Paauw is professor of medicine in the division of general internal medicine at the University of Washington, Seattle, and he serves as third-year medical student clerkship director at the University of Washington. He is a member of the editorial advisory board of Internal Medicine News. Dr. Paauw has no conflicts to disclose. Contact him at imnews@mdedge.com.
References
1. Pfeffer MA et al. Circulation. 2002;105(20):2341-6.
2. Cohen DE et al. Am J Cardiol. 2006;97(8A):77C-81C.
3. Hyogo H et al. Metabolism. 2008;57(12):1711-8.
4. FDA Drug Safety Communication: Important safety label changes to cholesterol-lowering statin drugs. 2012 Feb 28.
5. Cholesterol Treatment Trialists’ Collaboration. Lancet. 2022;400(10355):832-45.
6. Cohen JD et al. J Clin Lipidol. 2012;6(3):208-15.
7. Herrett E et al. BMJ. 2021 Feb 24;372:n1355.
8. Wood FA et al. N Engl J Med. 2020;383(22):2182-4.
9. Xu W et al. Ann Intern Med. 2024;177(6):701-10.