Initiating statins in the elderly: the evolving challenge.
OBJECTIVE
The lack of a strong evidence base in primary prevention, concerns for adverse effects, and inability to risk stratify elderly patients have led to underprescribing of statins in elderly patients. Our review will focus on statins in primary prevention, newer assessment tools for risk stratification, and statin safety.


RESULTS
Statin trials in secondary prevention consistently demonstrate significant coronary heart disease risk reduction in the elderly up to age 80 years. Limited data exist, however, in primary prevention in those aged over 75 years. Although the Prospective Study of Pravastatin in the Elderly at Risk included patients between the ages of 70 and 82 years, it did not show coronary heart disease risk reduction in primary prevention. Meta-analysis of statin trials, however, reveals significant coronary heart disease risk reduction in the elderly along with potential cerebrovascular accident risk reduction. Lower doses of statins may be required in the elderly due to drug interactions and differences in metabolism related to aging.


CONCLUSIONS
Statins have proven benefit in the elderly in those with coronary heart disease and diabetes mellitus. Future studies exploring statin efficacy in primary prevention for patients older than 75-80 years are needed along with better risk assessment tools. From a benefit risk perspective, the benefits of statin therapy in the elderly clearly outweigh the low risk of serious side effects.
Walker
D Benson
DB
Department of Medicine, Emory University, Atlanta, Georgia 30303, USA.
Jacobson
Terry A
TA
D000368:Aged; D002986:Clinical Trials as Topic; D003327:Coronary Disease / Q000517:prevention & control; D003925:Diabetic Angiopathies / Q000188:drug therapy* / Q000517:prevention & control; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D008875:Middle Aged; D017035:Pravastatin / Q000627:therapeutic use; D011322:Primary Prevention; D012449:Safety; D020521:Stroke / Q000517:prevention & control
D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D017035:Pravastatin