Are statins indicated for the primary prevention of CAD in octogenarians? antagonist viewpoint.
Statin therapy (3-hydroxy-3methylglutaryl coenzyme A reductase inhibitor) is beneficial for primary prevention of cardiovascular events in patients younger than age 65 years with hyperlipidemia, yet there is uncertainty about using these agents for primary prevention in octogenarians. We present the case that can be made for not treating octogenarians with statins for the primary prevention of cardiovascular disease. This case is built on three points: 1) cholesterol levels are not associated with cardiovascular disease events in octogenarians without overt coronary artery disease; 2) no randomized, controlled trials have assessed the role of statins in reducing events in octogenarians without coronary artery disease; and 3) statins may increase risks of myositis, rhabdomyolysis, and cancer in the elderly. In view of gaps in the current evidence and the resulting clinical uncertainty, it is unclear whether the balance of risk and benefit favors treatment for the primary prevention of coronary artery disease in octogenarians. The use of statins in this age group should be based on patient preference.
Foody
JoAnne Micale
JM
Department of Internal Medicine, Sections of Cardiovascular Medicine and Health Policy and Administration, Yale University School of Medicine, New Haven, CT, USA.
Krumholz
Harlan M
HM
D000368:Aged; D000369:Aged, 80 and over; D000924:Anticholesteremic Agents / Q000009:adverse effects*; D002784:Cholesterol / Q000097:blood; D003327:Coronary Disease / Q000517:prevention & control*; D006801:Humans; D006903:Hydroxymethylglutaryl CoA Reductases / Q000009:adverse effects*; D009220:Myositis / Q000139:chemically induced; D009369:Neoplasms / Q000139:chemically induced; D011322:Primary Prevention; D012206:Rhabdomyolysis / Q000139:chemically induced; D012307:Risk Factors
D000924:Anticholesteremic Agents; D002784:Cholesterol; D006903:Hydroxymethylglutaryl CoA Reductases