From the Guidelines
Statin medications are not routinely recommended for primary prevention in 88-year-old patients unless they have significant risk factors and good functional status, as the benefit-to-risk ratio diminishes with advancing age, especially beyond 85 years. When considering statin use in this age group, it's essential to weigh potential benefits against risks on an individualized basis 1. For secondary prevention in those with established cardiovascular disease, statins may provide benefit. The USPSTF recommends using the ACC/AHA Pooled Cohort Equations to calculate 10-year risk of CVD events, taking into account age, sex, race, cholesterol levels, systolic blood pressure level, antihypertension treatment, presence of diabetes, and smoking status as risk factors 1.
Some key points to consider when prescribing statins to elderly patients include:
- Starting with lower doses, such as atorvastatin (10-20mg daily), rosuvastatin (5-10mg daily), or pravastatin (20-40mg daily) 1
- Monitoring for side effects, particularly muscle pain, weakness, cognitive effects, and drug interactions
- Checking liver function tests and creatine kinase levels at baseline and periodically
- Considering the patient's overall health status, life expectancy, goals of care, and comorbidities
The decision to prescribe statins should be made on a case-by-case basis, taking into account the individual patient's characteristics and health status, as the current evidence is insufficient to assess the balance of benefits and harms of initiating statin use in adults 76 years and older 1.
From the FDA Drug Label
Atorvastatin calcium tablets are an HMG-CoA reductase inhibitor (statin) indicated: To reduce the risk of: Myocardial infarction (MI), stroke, revascularization procedures, and angina in adults with multiple risk factors for coronary heart disease (CHD) but without clinically evident CHD MI and stroke in adults with type 2 diabetes mellitus with multiple risk factors for CHD but without clinically evident CHD. Non-fatal MI, fatal and non-fatal stroke, revascularization procedures, hospitalization for congestive heart failure, and angina in adults with clinically evident CHD. As an adjunct to diet to reduce low-density lipoprotein (LDL-C) in: Adults with primary hyperlipidemia Adults and pediatric patients aged 10 years and older with heterozygous familial hypercholesterolemia (HeFH). As an adjunct to other LDL-C-lowering therapies to reduce LDL-C in adults and pediatric patients aged 10 years and older with homozygous familial hypercholesterolemia. As an adjunct to diet for the treatment of adults with: Primary dysbetalipoproteinemia. Hypertriglyceridemia.
The indication of statin medication, such as atorvastatin, for an 88-year-old patient is to reduce the risk of myocardial infarction (MI), stroke, revascularization procedures, and angina in adults with multiple risk factors for coronary heart disease (CHD), or to reduce low-density lipoprotein (LDL-C) in adults with primary hyperlipidemia or other conditions, as long as the patient's age is not a contraindication. Key considerations for this patient include:
- Age: The patient is 88 years old, which may increase the risk of myopathy and rhabdomyolysis.
- Dosage: The recommended starting dosage is 10 or 20 mg once daily, with a dosage range of 10 mg to 80 mg once daily.
- Contraindications: The patient should not have acute liver failure or decompensated cirrhosis, or hypersensitivity to atorvastatin or any excipient. 2
From the Research
Indication of Statin Medication for 88-Year-Old Patient
- The decision to prescribe statin medication for an 88-year-old patient should be made on a case-by-case basis, considering the patient's overall risk of atherosclerotic cardiovascular disease (ASCVD) and other clinical factors that influence their life expectancy and quality of life 3.
- While statin therapy is well established for primary and secondary prevention in adults 40 to 75 years of age, the evidence for its use in older adults is less clear 4, 3.
- For primary prevention, neither the ACC-AHA nor USPSTF cholesterol guidelines recommend statin therapy for patients over 75 years of age 4.
- However, moderate to high intensity statin therapy has been shown to decrease cardiovascular event rates in older patients with or at risk for ASCVD 3.
- Cardiac biomarkers and coronary calcium scoring can be used to identify older patients at higher ASCVD risk who may benefit from statin therapy 3.
- The potential benefits of statin therapy must be weighed against the potential risks, including adverse effects such as new onset diabetes, myopathy, and medication interactions 5, 4.
- Age alone should not be a deterrent to statin therapy in older patients, and the decision to initiate statin therapy should occur after a patient-clinician discussion based on the patient's overall ASCVD risk and other clinical factors 3.