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Statin Therapy in Older Adults for Primary Prevention of ASCD: The Balancing Act

Expert Analysis

It is well established that statins reduce adverse cardiovascular outcomes but it remains unclear whether this reduction applies to older adults. Although older individuals have the highest absolute risk for atherosclerotic cardiovascular disease (ASCVD) events, the US guidelines for blood pressure and cholesterol recommend lower-intensity, less-aggressive treatment strategies in this high-risk population. The 2018 American College of Cardiology (ACC)/American Heart Association (AHA) Cholesterol guidelines,1 citing the statin-associated reduction in ASCVD morbidity burden in older adults in secondary prevention, recommend ongoing use of statins in this population. However, when addressing primary prevention in older adults (>75 years), the recommendations are less direct and weigh heavily on the patient-physician discussion as well as overall concerns for polypharmacy, fraility, and life-expectancy.

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