From the Guidelines
Starting a 73-year-old on a statin is generally recommended if they have established cardiovascular disease or are at high risk for cardiovascular events, as the benefits of statin therapy in reducing morbidity and mortality outweigh the risks. When considering statin therapy in older adults, it's essential to evaluate the potential for cardiovascular risk reduction, adverse effects, and drug-drug interactions, as well as patient frailty and patient preferences 1. For patients with clinical atherosclerotic cardiovascular disease (ASCVD), high-intensity statin therapy is recommended for those 75 years of age or younger, with the aim of achieving a 50% or greater reduction in LDL-C levels 1. However, for patients older than 75 years of age with clinical ASCVD, it is reasonable to initiate moderate- or high-intensity statin therapy after evaluation of the potential benefits and risks, as well as patient preferences 1. Some key points to consider when initiating statin therapy in older adults include:
- Starting at a lower dose and gradually increasing as tolerated while monitoring for side effects such as muscle pain 1
- Regular monitoring of liver function tests and creatine kinase levels, particularly during the first few months of therapy
- Individualizing the decision based on the patient's overall health status, life expectancy, functional status, and preferences
- Balancing the potential benefits of statin therapy against the risks of drug interactions, polypharmacy concerns, and age-related changes in drug metabolism 1. In terms of specific statin choices, atorvastatin (10-20 mg daily) or rosuvastatin (5-10 mg daily) are typically appropriate options for primary prevention in older adults. Ultimately, the decision to start a 73-year-old on a statin should be based on a comprehensive evaluation of the patient's individual risk factors, health status, and preferences, with the goal of reducing morbidity and mortality while minimizing potential harms.
From the Research
Statin Therapy for a 73-Year-Old
When considering whether to start a 73-year-old on a statin, several factors must be taken into account, including the patient's overall health, cardiovascular risk factors, and potential benefits and risks of statin therapy.
- The patient's age is a significant risk factor for cardiovascular disease, and statins have been shown to be effective in reducing the risk of atherosclerotic cardiovascular disease (ASCVD) in older adults 2, 3.
- However, statins may not be sufficient to decrease LDL cholesterol levels in all patients, and some may require additional therapy, such as ezetimibe or PCSK9 inhibitors, to achieve optimal lipid levels 2, 4, 3, 5, 6.
- The combination of a statin with ezetimibe has been shown to be effective in reducing LDL cholesterol levels and improving cardiovascular outcomes in patients with hypercholesterolemia, including those at high risk for ASCVD 4, 5.
- PCSK9 inhibitors have also been shown to be effective in reducing LDL cholesterol levels and improving cardiovascular outcomes in patients with ASCVD, although their high cost and potential adverse effects must be carefully considered 2, 3, 6.
Considerations for Initiating Statin Therapy
Before initiating statin therapy in a 73-year-old, the following considerations should be taken into account:
- The patient's cardiovascular risk factors, including hypertension, diabetes, and smoking status, should be assessed to determine the potential benefits of statin therapy 2, 3, 6.
- The patient's lipid profile, including LDL cholesterol, HDL cholesterol, and triglyceride levels, should be evaluated to determine the need for statin therapy and to monitor the effectiveness of treatment 2, 4, 3, 5, 6.
- The potential risks and benefits of statin therapy, including the risk of adverse effects such as myalgia and liver enzyme elevation, should be carefully considered and discussed with the patient 2, 4, 3, 6.