Statin Therapy for Primary and Secondary Prevention in Older Adults

Abstract

Purpose of review: Although statin therapy is well established to prevent atherosclerotic vascular disease (ASCVD) events in adults 40 to 75 years of age, it is less clear whether older adults benefit from statin therapy. The purpose of this review is to summarize the current evidence and guidelines on statin use for primary and secondary prevention in older patients.

Recent findings: Moderate to high intensity statin therapy decreases cardiovascular event rates in older patients with or at risk for ASCVD. Cardiac biomarkers and coronary calcium scoring can identify older patients at higher ASCVD risk who may benefit from statin therapy. Age alone should not be a deterrent to statin therapy in older patients. The decision to initiate statin therapy should occur after a patient to clinician discussion based on the patient's overall ASCVD risk and weighed against other clinical factors that influence the patient's life expectancy and quality of life.

Keywords: ASCVD prevention; LDL cholesterol reduction; Older adults; Statins.

Fig. 1

*CV risk factors: type 2 diabetes, active smoking, uncontrolled hypertension, chronic kidney disease †Very high-risk patients include those with recent ACS within the past year, history of myocardial infarction, history of ischemic stroke, and symptomatic peripheral arterial disease plus other CV risk factors. Adapted from the 2018 AHA/ACC/Multisociety guideline [4]. Abbreviations: CV = cardiovascular; LDL-C = low-density lipoprotein cholesterol; CAC = coronary artery calcium; hsCRP = high-sensitivity C-reactive protein