I have the same question

according to the guideline，aspirin+plavix+statin therapy is basic medicine for atherosclerosis

in fact ，the pathology of the cardiovascular or cerebrovascular in older patients is atherosclerosis，

aspirin+plavix therapy will increase the blood event，so we be very carefully to used them by reduce dosage，or not used，

then if we are not to start statin therapy now，how we are to do？

According to the new guides, these are the patients who benefit with statins:

1) Patients with clinical atheroesclerotic disease

2) Patients with LDL above 190 mg/dl.

3) Patienst diagnosed with diabetes mellitus with an age between 40 and 75 years old and LDL between 70-189 m/dl.

4) Patients between 40 and 75 years old without diabetes, without atheroesclerotic disease and ASCVD risk between 7.5% and LDL between 70-189 mg/dl.

For people above 80 years old you should consider to initiate statins if:

1) They have LDL above 190 mg/dl.

2) If they have clinical atheroesclerotic disease.

For people above 80 years, ASCVD risk does not count.

But anyway, you have to take into account that almost every person above 80 years old will have some degree of atheroesclerotic plaques. The formation of these plaques is inherent to the aging process. So, almost every person above 80 years old will be beneficiated with statins treatment. I have patients above 90 years old who are taking atorvastatin. I think every aged person might be benefitiated of these treatments, except, of course, if there is a clear contraindication e.g backgroud of rabdomiolisis or hepatic disease or transaminases elevation, or an hipersensitivity reaction.

I think that advanced age should be of somewhat lesser importancce in making decision for starting statins. However,  indication should meet relevant practice guidelines and in comprehensive way include assessment of effects in correlation of individualized characteristics of aged patient (as comorbidities, renal or liver function), as well as drug agent chosen (safety profile, sideeffects, pharm.kinetics,etc)

There is a cholesterol conundrum. People over 80 years of age live longer if they have higher cholesterol levels. So I would not start a statin therapy in someone aged over 80 years unless he has had a myocardial infarction. However I would not stop a statin therapy which has been installed long before, because stopping statin therapy has been shown to be associated with a bad outcome (even worse than if no  statin had ever been given)

I think a person over 75 -80 years of age who are taking statins should continue treatment, as withdrawal of such may have adverse effects at the level of vascular reactivity. However I do not think it's appropriate to start treatment because their glomerular filtration has dropped to less than 60 ml / min, or moderate diabetes is newly detected with an LDL cholesterol of approximately 120 mg / dl .. As Walter says, people over 80 years of age live longer if higher cholesterol levels They have. We can not forget that statins have side effects and these may outweigh the benefits when life expectancy is short and there is a possible polypharmacy.

To Juan Gomez and Walter: Do you have the studies which show that people over 80 years of age live longer if higher cholesterol levels ? Is that in the new ATP guides ? Thank you.

It is not in the ATP Guidelines.

 2 important studies which show this phenomenon are

The metaanalysis by Petersen LK et al Age and Ageing 2010;39:674-680 and the publication by

Newson RS J Am Geriatr Soc 2011;59:1779-85

There is no specific guideline to my knowledge about age and use of statin. There is no data on octogenerians to my knowledge. However,  we use it for secondary prevention modification and the dose of any statin is determined by the clinical event. For example,  statin naive acute coronary syndrome would receive 40mg of simvastatin and patients with simvastatin would get Atorvastatin.  Othet considerations are taken into account such as comorbidities such as polymyalgia, CK levels and lipid profile.

As an example for these reviews we may consider the following cases:

:

Case1. Female 81 years, with LDL of 120 mg / dl, HDL 50 mg / dl, Lp (a) 20 mg / dl and eGFR of 70 ml / min, treated with antihypertensives (supposedly high risk according to the latest recommendations ); you consider it appropriate to initiate treatment with half-dose statins ?, and if so, there is objective evidence of their benefit, indeed, a positive risk / benefit ratio?

Case 2. 81 years, with LDL of 85 mg / dl, HDL 40 mg / dl, Lp (a) 20 mg / dl, serum glucose of 135 (maintained), HbA1c of 7.0% and eGFR of 25 ml / min, treated with antiplatelet agents (supposedly very high risk according to the latest recommendations); you consider it appropriate to initiate treatment with high doses of statins ?, and if so, there is objective evidence of their benefit, indeed, a positive risk / benefit ratio?

Answer to Juan Gomez:

Case 1: Cardiovascular Risk (ASCVD risk) does not count for people over 80 years. According to your information, she has no clinical atheroesclerotic disease (carotid disease, angina, coronary disease, background stroke in the last year, etc) , and she has an LDL under 190. Conclusion: She will not be benefitiated if she starts statin therapy. I recommend lifestyle changes and keep blood pressure controled. It is for good prognosis the GFR (it is over 60) and that she does not have diabetes.

Case 2: Cardiovascular Risk (ASCVD risk) does not count for people over 80 years, not even for diabetic people. According to your information, the person has no clinical atheroesclerotic disease (carotid disease, angina, coronary disease, background stroke in the last year, etc) , and  has an LDL under 190. Conclusion: Probably the person will not be benefitiated if starts statin therapy. I recommend lifestyle changes and control of the glicemic levels. Pay attention to the GFR, it is a 4 stage. The person has to be under treatment of a nephrologist.

The studies suggest that statin therapy in individuals over 80 years might have benefits as secondary prevention, but this is not clear for primary prevention. The benefits of the use of statins for primary prevention  in very old people with diabetes are not clear. Strandberg et al. recommend careful surveillance for conditions predisposing to statin adverse effects, and if the physician decides to initiate therapy,  should start with low- to moderate intensity statin regimen.

Just a reflexion: To be alive at the age  of 80 (with current technologies) is a huge achievement for a human being.  I am sure you have done your best. People over 80 need all our love and understanding. Of all treatments, that is the best one.

the attached may be useful in the decision process

Thank you Robert. I think it's a very interesting article and that all we are interested in this topic have to read.