Should Statins Be Started in Patients Over 80?
the MPR take:
Hypercholesterolemia is common among patients >80 years, yet research is lacking on the safety and efficacy of hypercholesterolemia medications in this patient population. Due to underreporting and prevalence of subclinical disease, incidence of atherosclerotic cardiovascular disease (ASCVD) event may be underestimated for this population, making it difficult to predict which older patients will benefit from primary prevention. In a literature review published in the Journal of the American Medical Association, no randomized clinical trials (RCTs) were found investigating the use of statins or other hypercholesterolemia medications in patients >80 years. Other RCTs on patients ages 75–80 years have found a reduced ASCVD event rate with a decline in LDL-C; thus, the ACA/AHA guidelines recommend the continued use of statins in patients ≥75 years already taking and tolerating this medication. Because older patients are physiologically heterogeneous, potential adverse effects are important to consider in hypercholesterolemia treatment, especially muscle-related effects and any secondary causes like liver or kidney disease, hypothyroidism, or use of atypical antipsychotics. It is advised that treatment for hypercholesterolemia begins prior to age 80, but if therapy is initiated after that, decisions must be made carefully due to a lack of high-quality empirical evidence.
Importance: Hypercholesterolemia is common among people older than 80 years. Substantial functional heterogeneity exists among older patients, and decision making for statin use differs in older patients relative to younger ones. Evidence Review: MEDLINE and other sources were searched from January 1990 to June 2014.
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