Should a lipid panel be continued for an 84-year-old female patient (female) undergoing a wellness examination who is not currently taking lipid-lowering medications (medications)?

From the Guidelines

For an 84-year-old female coming in for wellness, routine lipid panel screening is generally not recommended. The U.S. Preventive Services Task Force does not recommend lipid screening in adults over 75 years who are not on lipid-lowering therapy, as the benefits of starting treatment at this age are limited 1. The potential harms of medication side effects often outweigh cardiovascular benefits in this age group, as statin therapy typically takes 2-5 years to demonstrate meaningful risk reduction. Additionally, competing mortality risks become more significant with advanced age. However, if the patient has existing cardiovascular disease, diabetes, or other high-risk conditions, continued monitoring may be appropriate as part of ongoing management, as suggested by the standards of medical care in diabetes-2022 1. The decision should ultimately be individualized based on the patient's overall health status, life expectancy, preferences, and goals of care. A discussion with the patient about the limited value of screening and focusing instead on other aspects of geriatric wellness, such as lifestyle modifications, including a Mediterranean diet and increased physical activity, would be more beneficial 1.

Some key points to consider in this decision include:

• The patient's age and the limited benefits of starting lipid-lowering therapy at this age
• The potential harms of medication side effects and the need to weigh these against potential cardiovascular benefits
• The importance of individualizing the decision based on the patient's overall health status and goals of care
• The value of focusing on other aspects of geriatric wellness, such as lifestyle modifications and management of existing health conditions.

It is also important to note that the standards of medical care in diabetes-2022 suggest that lipid profiles should be obtained at the time of diabetes diagnosis, at the initial medical evaluation, and every 5 years thereafter if under the age of 40 years, or more frequently if indicated 1. However, for an 84-year-old female, the benefits of routine lipid panel screening are likely to be limited, and a more individualized approach is necessary.

From the Research

Lipid Panel Check for an 84-Year-Old Female

• The patient is coming in for a wellness check and is not on any medications.
• According to the study 2, there is no clear optimal level of total cholesterol (TC) for individuals aged 80+, and low TC (<5.5 mmol/l) is associated with the highest mortality rate in this age group.
• The same study 2 also found that lipid-lowering treatment did not have a significant effect on total mortality in 80+-year-old individuals, and it is possible that statins may increase all-cause mortality in this group without cardiovascular disease.
• Another study 3 found that statin treatment in elderly patients reduces all-cause mortality, coronary heart disease mortality, non-fatal myocardial infarction, and stroke, but the benefit starts beyond 1 year of treatment.
• However, this study 3 also notes that treatment decisions should consider the individual patient's situation, including multimorbidity, polypharmacy, and patient wishes.
• There is no direct evidence to suggest that checking lipid panels is necessary for an 84-year-old female who is not on medications, especially considering the potential risks and benefits of lipid-lowering treatment in this age group 2, 3.
• The study 4 discusses the importance of lipid-lowering therapy in cardiovascular disease, but it does not provide specific guidance for individuals aged 80+ who are not on medications.
• The studies 5 and 6 discuss the management of dyslipidemia and the use of lipid-lowering medications, but they do not provide specific recommendations for an 84-year-old female who is not on medications.