Are Cholesterol Lowering Medications Right for Older Adults?

While useful for many patients, statins may not be the right choice for seniors.
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Statins were a great advance for heart disease, giving primary care physicians a treatment option for lowering cholesterol that had not existed before. Because of a great deal of research showing their effectiveness in preventing cardiovascular disease they have become one of the most commonly prescribed medicines. They are effective both in preventing heart attacks and strokes, as well as preventing their recurrence. But are they right for older adults?

Recently Jefferson primary care physician Dr. Neil Skolnik, who treats patients in Abington, had a viewpoint essay published in JAMA, one of the most prestigious medical journals, that garnered a great deal of attention on statin use in seniors over 75.

Dr. Neil Skolnik

In that essay, he disagreed with the recent American Heart Association recommendations that suggested “it may be reasonable” to prescribe statins to almost all adults over age 75 – whether or not they have a history of cardiovascular disease or heart attacks. He argues that there is a lack of evidence that statins can actually help this group of older adults.

Dr. Skolnik explains why patients and physicians might want to carefully consider whether statins are the right choice in seniors over 75, and suggests questions patients should bring up when they speak to their  doctors.

Q: What is some of the evidence that suggests statins might not be right for patients over the age of 75?

There is a lot of evidence that statins are very helpful and decrease the rate of future events for older adults (those over 75) who have had a heart attack or stroke.  On the other hand, there simply is no evidence that it helps prevent a first heart attack or stroke in this older generation. It’s not so much that the evidence says it doesn’t work, rather it is that there is no evidence that it does work. And this question is currently being explored by further clinical trials.

Q: Are there risks for seniors over 75 who take statins?

Statins are generally considered a safe medication, though they do have some side effects.  We know that for all individuals, including those over age 75, a good diet and regular exercise are the two most important things that you can do for your health. Statins can cause muscle aches when exercising, which can interfere with this natural way of protecting heart health.  There is some evidence suggesting that statins also occasionally cause problems with sharpness of thinking and may increase the risk of developing type 2 diabetes in some individuals.

Q: Are there certain populations of people over the age of 75 who might benefit from statins?

Statins are important medications for people who have already suffered a cardiovascular event, including a heart attack, angina, a stroke, or who have peripheral vascular disease. They have been used safely and shown to reduce risk of cardiovascular events in at-risk patients.

Q: What are some of the questions patients over the age of 75 should ask their doctors to help decide if statins are right for them?

If you are over 75 and healthy and do not have a history of cardiovascular disease, a good question to start with is, “do I really need this medication?”  You can follow with the question, “Since I have done this well so far, is there a good reason to think that I will benefit by taking this medication?”

 

 

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