Lipid-Targeted Atherosclerotic Risk Reduction in Older Adults: A Review

Abstract

Aggressive lipid-lowering lifestyle modifications and pharmacologic therapies are the cornerstones of the primary and secondary prevention of atherosclerotic cardiovascular disease events. While statins are highly effective, inexpensive, and generally well-tolerated medications, many clinicians and patients express uncertainty regarding the necessity of statin treatment in older adults. Citing concerns such as polypharmacy, muscle symptoms, and even potential cognitive changes with statins, many patients and health care providers elect to de-intensify or discontinue statin therapy during the process of aging. A lack of clear representation of older individuals in many clinical trials and practice guidelines may contribute to the ambiguity. However, the recently prevailing data and practice patterns supporting the benefits, safety, and tolerability of a variety of lipid-lowering therapeutics in older adults are discussed here, with particular mention of a potential protective effect from incident dementia among a statin-treated geriatric population and an admonishment of the historical concept of “too-low” low-density lipoprotein cholesterol (LDL-C) levels.

Statin utilization and cardiovascular outcomes in a real-world primary prevention cohort of older adults

“…Shown in our analyses, statin utilization is low among older adults for primary prevention. Medical provider inertia in using statins, due to myalgias and various factors in older adults is a well-documented phenomenon [ 26 , 27 ], however, based on our results, this intervention is likely needed given reduction in ASCVD events. While myalgias are a common reason for statin discontinuation or lack of initiation, it has been shown that many patients experience myalgias with similar frequencies whether on a statin or placebo indicating that this may be a psychological reaction [28] .…”

“…Many major guidelines rely on having a discussion between the patient and provider about the initiation of a statin in individuals older than 75 years of age [1] . Lack of concrete guideline directions on statin use in older adults for primary prevention is likely due to the paucity of evidence and lack of recruitment of the aging adults in randomized controlled trials [ 27 , 31 ]. Our work can add to the literature to support clear guidelines for statin use among at least high-risk older adults.…”