Statins for the primary prevention of cardiovascular events in older adults: a review of the evidence.
BACKGROUND
Although statins have been demonstrated to be beneficial for secondary prevention in the elderly, their use for primary prevention has not been well described.


OBJECTIVE
In this review, we summarize data regarding the efficacy, safety, and current recommendations for statins for the primary prevention of cardiovascular events in older adults.


METHODS
This review is based on a computerized literature search of the PubMed database for articles published in the English language from January 1980 to June 2006. Key words searched individually and cross-referenced included: statins, HMG-CoA reductase inhibitors, cholesterol, elderly, aged, cardiovascular disease, primary prevention, risk stratification, and C-reactive protein. This search produced 445 citations; reference lists revealed an additional 12 citations, all of which were screened for relevance to the topic.


RESULTS
The existing evidence suggests, but does not confirm, benefit from the use of statins for primary prevention in the elderly subgroup (ie, those aged >65 years). Of the 6 published trials of statins for primary prevention, only 3 included subjects aged >75 years, and subgroup results in older adults are unavailable. Current guidelines recommend statins for individuals based on their assessed cardiovascular risk.


CONCLUSIONS
Extension of treatment guidelines should consider an individual's global risk of coronary heart disease. However, due to the prevalence of subclinical disease in older adults, risk may be higher or otherwise differ with age. In addition, tolerance for and barriers to adherence with long-term medical therapy are important treatment considerations in older adults. Prospective, randomized controlled trials that better define the tolerability, safety, and efficacy of statin therapy in older adults with elevated cholesterol levels and intermediate cardiovascular risk are needed.
Ali
Robin
R
Division of Geriatric Medicine, Department of Medicine, Duke University Medical Center, Durham, North Carolina 27710, USA. robin.ali@mc.duke.edu
Alexander
Karen P
KP
D000368:Aged; D000375:Aging; D002318:Cardiovascular Diseases / Q000517:prevention & control*; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D006937:Hypercholesterolemia / Q000188:drug therapy; D008297:Male; D015201:Meta-Analysis as Topic; D010349:Patient Compliance; D017410:Practice Guidelines as Topic; D011322:Primary Prevention; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors
D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors