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[Statin and cardiovascular diseases after 75 years]
F Retornaz1, S Beliard2, E Gremeaux3
1Centre gérontologique départemental, 176, avenue de Montolivet, 13012 Marseille, France; Institut Silvermed, 176, avenue de Montolivet, 13012 Marseille, France; Laboratoire de santé publique, évaluation des systèmes de soins et santé perçue, EA 3279 UFR médecine Aix-Marseille université, 27, boulevard Jean-Moulin, 13385 Marseille Cedex 05, France; Unité de recherche et de soins en médecine interne et maladies infectieuses, hôpital européen, 6, rue Desirée-Clary, 13003 Marseille, France.
Insights
Statin use in older adults over 75 or with frailty is debated. While recommended for secondary prevention, primary prevention requires careful risk assessment due to potential side effects.
Area of Science:
- Geriatric Medicine
- Cardiology
- Pharmacology
Background:
- Statin therapy in elderly patients (over 75) or those with frailty presents complex clinical questions.
- Concerns include the role of cholesterol in atherosclerosis, treatment benefits for primary/secondary prevention, and adverse effects in polypathology and polypharmacy contexts.
Purpose of the Study:
- To review available literature regarding statin prescription in elderly individuals and those with frailty.
- To address the uncertainties surrounding cholesterol's role, treatment efficacy, and safety in this demographic.
Main Methods:
- Literature review of existing data on statin use in the target population.
- Analysis of evidence pertaining to primary and secondary prevention strategies.
Main Results:
- Statin prescription is advised for secondary prevention in older adults, irrespective of age, but intensive regimens should be approached cautiously.
- For primary prevention, there is no established consensus; decisions should integrate geriatric and cardiovascular risk evaluations.
Conclusions:
- Statin use in the elderly requires a nuanced approach, balancing benefits against potential risks.
- Individualized risk-benefit assessments are crucial, particularly for primary prevention in frail or very old individuals.
Abstract:
Statin prescription in persons older than 75 years or with frailty signs raises questions on the role of cholesterol in the genesis of atherosclerosis in this population, on the benefit of this treatment in primary or secondary prevention, and on their side effects in a context of multiple pathology and multiple medications. These questions are approached with the available literature data for this population. In secondary prevention, statin prescription is recommended whatever the age although intensive treatment should be avoided. In primary prevention, in the absence of consensus, their prescription depends on both geriatric and cardiovascular risk assessment.
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