For adults 76 years of age and older without a history of heart attack or stroke, the USPSTF concludes that not enough evidence is available to assess the balance of benefits and harms of statin use for the prevention of CVD events. This is a Grade I recommendation, meaning evidence is very limited.  Some evidence suggests a link between lower cholesterol levels and an increased risk of mortality with advanced age.  While little evidence of benefit exists, this does not seem to curtail prescribing of these medication to elderly patients. A study published in JAMA Internal Medicine notes that the use of statins for primary prevention in patients older than 79 years of age without vascular disease increased from 1999–2012 despite little evidence supporting their use in this patient population.

The USPSTF recommendations while closely aligned with the American College of Cardiology (ACC)/American Heart Association (AHA) guidelines, may leave some prescribers and patients confused. The ACC/AHA guidelines state that all patients ages 40–75 with LDL cholesterol levels of 70–189mg/dL with an estimated 10-year risk of heart disease of 7.5% or more should be initiated on cholesterol-lowering medication, however, the USPSTF recommendation leans more towards individualized decision-making for those patients that fall between 7.5% and 10%.

In an interview conducted by MPR in 2013, shortly after the ACC/AHA guidelines were published, Dr. Robert Eckel, co-author of  the Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults, said ” A guideline is not a mandate. Practitioners must use their clinical judgment on a case-by-case basis.  And they must remember that lifestyle changes are critical in primary prevention. I recognize that the concept of treating the whole patient rather than the patient’s numbers is a major paradigm shift that will be adopted slowly, but it will ultimately lead to an important reduction in ASCVD events.”