Implications of statin adverse effects in the elderly

The elderly differ from younger people in the relation of cholesterol to heart disease and mortality. Clinical trial evidence supports epidemiological findings in showing that high cholesterol weakens in its relationship to heart disease with age and loses (and in older age reverses) its relation to mortality. Randomised trial data confirm that lowering cholesterol no longer extends life in the elderly, even those at high risk of heart disease, and no evidence supports the presumption that the impact on all-cause morbidity is any more favourable. These findings increase the importance of statin adverse effects (AEs) in this group. Furthermore, the elderly may be more vulnerable to known AEs, and evidence provides cause for concern that new risks may supervene, including cancer, neurodegenerative disease and heart failure. Physiological evidence regarding the impact of statins on mitochondrial function, and mitochondrial function on ageing, support these concerns. Additionally, the impact of statin AEs (e.g., muscle and cognitive problems) may be amplified in this group. Effects may be misattributed to ageing. Even modestly lower cognitive and physical function in older elderly prognosticates increased disability, hospitalisation, institutionalisation, and mortality. Disability, once present, is less likely to recover. Because the risk for AEs is unattended by evidence of net benefit to the person, the use of statins in the elderly should be undertaken, if at all, with circumspection and close scrutiny for adverse effects.