Avoid using statins for primary prevention in older adults without an individual assessment of benefits and risks

Ongoing statin therapy should be discontinued in cases of illness that reduce the expected benefit of treatment, such as severe cancer, malnutrition, organ failure, or moderate to severe dementia. 
Statins are recommended for secondary prevention in older adults as in younger individuals, unless overall health status or life expectancy is significantly compromised. 

Treatment with statins in individuals over 75 years has been shown to reduce cardiovascular morbidity similarly to younger populations. In secondary prevention, statins have demonstrated a reduction in cardiovascular events and mortality. However, in primary prevention, few studies exist for this age group, and while available data indicate a similar reduction in cardiovascular events, there is no clear effect on mortality. Randomized studies and meta-analyses have not reported a significant incidence of severe side effects, but observational studies suggest a slightly higher occurrence of gastrointestinal side effects and muscle pain. The risk of side effects is higher in individuals with low body weight, women, those over 80 years old, at higher doses, and in cases of comorbidities or polypharmacy. 

We recommend initiating and continuing statin therapy in older adults (over 75 years) with known cardiovascular disease in the same way as for younger patients, unless their health status or life expectancy is significantly reduced. Primary prevention in older adults should only be considered after an individual clinical assessment of benefits and risks, with particular attention to comorbidities and polypharmacy. Statin therapy should be discontinued in cases where the expected benefit is reduced, such as severe cancer, malnutrition, organ failure, or dementia. 

References:

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• Kristjansson SR, Wyller TB. Avslutning av forebyggende legemiddelbruk hos eldre. Tidsskr Nor Legeforen 2010; 17(130):1727-28.
• Savarese G, Gotto AM, Paolillo S, D'Amore C, Losco T, Musella F, et al. Benefits of statins in elderly subjects without established cardiovascular disease: a meta-analysis. J Am Coll Cardiol. 2013 Dec 3;62(22):2090-9. doi: 10.1016/j.jacc.2013.07.069.
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