Statins have an important role in the treatment and prevention of cardiovascular disease, but the question of uncertainties regarding their risk-benefit ratio for elderly patients is often raised.
When initiating statin therapy it is important to take into account age-related pharmacodynamic and pharmacokinetic changes that increase the risk of statin adverse reactions. Also, possible drug-drug interactions, co-morbidities that shorten life expectancy and assumed therapy adherence should be taken into account. Population of the elderly patients is very heterogenous in terms of chronological age, ageing-related biological changes, co-morbidities and indications for a statin (primary or secondary prevention). For statins in secondary prevention, there is consistency among international guidelines and relevant publications that statins are indicated regardless of the age.
Although an individual approach for the use of statins in primary prevention according to the cardiovascular (CV) risk is recommended, many international guidelines recommend starting statin therapy in all patients under 75 years of age with elevated CV risk. Chronological age > 75 years does not represent per se a contraindication to initiate statin in primary prevention but parameters as co-morbidities, frailty, life expectancy and expected drug adherence have to be considered. In conclusion, chronological age is not a reason to avoid statins because patients with the same age could significantly differ regarding their health status and vitality/frailty.
The question a clinician should ask himself is whether the expected time to benefit from statin treatment will be longer than the expected time to harm (adverse effects) or the expected patient's life expectancy.
You can read more about this topic in the next issue of Pharmaca (in Croatian) in the article authored by Suzana Mimica and Zvonimir Čagalj.