Should you be taking statins after age 75?

The absence of convincing evidence makes it easy to doubt the drugs' benefit in older adults, a UW Medicine cardiovascular specialist says.

The New York Times recently addressed the topic of people over age 75 taking statins for the prevention of heart disease. Statins, drugs that lower cholesterol, are clearly for the tens of millions of Americans who have had a heart attack, stroke or heart disease, or vessel blockage, regardless of age. 

Guidelines issued in 2013 by the American Heart Association also recommend statins for the general population up to age 75 – people in good health with no history of cardiovascular disease – for the purpose of preventing first heart attacks or strokes. 

But does taking statins make sense for people older than 75?  Probably not for someone with a life-limiting illness, said Dr. Bruce Psaty, a UW Medicine internist and epidemiologist who specializes in cardiovascular health.

“The purpose of taking statins is prevention of cardiovascular disease, and the horizon here is thought of in terms of five to 10 years,” he said. “We have lots of evidence of benefit in middle-aged adults (at normal risk) – tens of thousands of patients evaluated in randomized trials.  The data are much less rich in older adults, and the absence of convincing evidence makes it easy to doubt the benefit in older adults.”

Nevertheless, he said he’d be happy to prescribe a statin preventatively for someone who is 75 or older, otherwise healthy and who has a reasonable life expectancy – “if that is their wish.”

Preventive therapies are a patient’s choice, Psaty emphasized. Some patients don’t want to commit to taking medications long-term or are concerned about side effects. Others are so concerned to avoid heart attacks or strokes that they are eager to take preventive therapies.

Older adults who have been taking statins as a preventive measure, or whose primary caregiver presents the drugs for consideration, might find value in discussing statins’ health risks and benefits with their physician.

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