Statins in the elderly: a patient-focused approach.

Individuals age >65 years represent the fastest-growing subpopulation in the United States. Although these individuals with the highest cardiovascular risk profile would be anticipated to be the most aggressively treated, paradoxically, treatment and baseline risk are inversely related. Presumably, the elderly population would benefit from high-intensity statin therapy; however, as per the 2013 American College of Cardiology/American Heart Association guidelines, given the scarcity of evidence in patients age >75, there are only sufficient data from randomized controlled trials to support use of moderate-intensity statin therapy for secondary prevention. Despite evidence demonstrating statins are beneficial in the elderly, the decision to initiate and sustain treatment should be a well-informed and collaborative decision. One must balance the benefits (secondary atherosclerotic cardiovascular prevention, stroke reduction, decreased morbidity and mortality) with the potential risks to the elderly (altered metabolism, comorbidities, polypharmacy and drug-drug interactions, side effects, cognitive limitations, and cost).