Statin therapy for primary cardiovascular prevention in adults older than 75 years

Cardiovascular disease (CVD) is a major contributor to morbidity and mortality worldwide. An abundance of research demonstrated that low‑density lipoprotein cholesterol (LDL‑C) is an important risk factor for CVD that can be modified with the drug class hydroxymethylglutaryl‑CoA reductase inhibitors, or statins.Statins have an unequivocal benefit in reducing CVD risk across age groups for secondary prevention. However, the benefit of these drugs for primary prevention in adults older than 75 years of age remains equivocal and controversial. The global population is aging rapidly and primary CVD prevention recommendations to guide statin therapy above the age of 75 years are necessary. However, current trends in statin therapy illustrate that it is underutilized for primary prevention in that age group. Concerns exist regarding the higher incidence of common adverse events from statin use in the older population; however, there are no confirmatory data regarding these associations. In the light of available evidence, it is reasonable to offer statin therapy for primary prevention to all older individuals following a shared decision‑making process that takes life expectancy, polypharmacy, frailty, and potential adverse effects into consideration. Combination therapies with other agents for the management of dyslipidemia should be considered to facilitate the use of tolerable doses of statins. Future investigations of dyslipidemia therapies must appropriately include this at‑risk population to identify optimal drugs and drug combinations that have a high benefit‑to ‑risk ratio for the prevention of CVD in the very old.