Lipid-lowering therapy for cardiovascular risk management in the older patients: how far should we go?

Age is a nonmodifiable risk factor for atherosclerosis and cardiovascular disease (CVD), with their prevalence increasing over time. Dyslipidaemia plays a key role in coronary artery disease (CAD) across all age groups, including older adults. However, limited evidence exists regarding the efficacy of lipid-lowering therapy, particularly statins, for primary prevention in older populations. This review underscores the significance of statins for primary prevention in older adults. The PROSPER study and similar trials demonstrated a 24% reduction in CAD mortality with statins, without notable cognitive or functional impairments. Similarly, the EWTOPIA 75 trial reported a 34% reduction in major cardiac events with ezetimibe, though benefits diminished in those aged >85 years. A meta-analysis revealed a 26% reduction in major vascular events per 1 mmol/L decrease in low-density lipoprotein cholesterol in older adults, with no heightened risks of cancer, haemorrhagic stroke, or cognitive decline. The Danish Contemporary Primary Prevention Cohort identified individuals aged 80-100 years as having the highest myocardial infarction risk, emphasizing the benefits of statin therapy in this group. Ongoing STAREE and PREVENTABLE trials aim to provide further evidence on statins for primary prevention in older adults. Effective CVD management in older populations should begin early, prioritizing a healthy lifestyle and addressing modifiable risk factors. Statin therapy should not be discontinued based on age alone and requires careful consideration for individuals with established CVD.