I’m not certain what credibility remains of health care practitioners in the eyes of the public, that is if they followed the recent debate and harsh criticism of the recently released blood cholesterol treatment guidelines http://content.onlinejacc.org/article.aspx?articleid=1770217 from the American College of Cardiology and the American Heart Association. But I’m fairly certain it parallels the credibility of our political leadership on both sides of the aisle. What is most important for older adults is to NOT react to what you read without first having an informed discussion with your physician, and if you’re not satisfied with that conversation then you should seek further opinion from others who are qualified.
The recent guidelines have been criticized by many professional groups, yet there is still good information to glean from them. What I find interesting is that, since the authors used only randomized controlled trials, the strongest type of evidence, they found evidence to put the age cutoff for modified use at 75 years old. If you read previous posts on this blog on the adverse effects of statins in older adults it helps paint the clear picture that many older adults are over-treated and suffer from the adverse effects of statins.
If we refer to the guidelines where there are age-specific recommendations for older adults, here’s where older adults should consider taking a statin, and I emphasize consider taking a statin since lifestyle changes in diet and exercise are hugely beneficial in reducing cardiovascular risk.
- LDL cholesterol is over 190, then consider taking a statin. However, moderate-dose use is recommended for older adults. High-intensity use is associated with a much higher risk for adverse effects.
- Diagnosis of a form of atherosclerotic cardiovascular disease (ASCVD), meaning a history of : heart attack, angina, stroke, TIA (transient ischemic attack), peripheral vascular disease, revascularization (ask your doctor), and acute coronary syndrome. However, please note well that the use of statins in those with a history of hemorrhagic stroke is not well supported and may actually increase the risk for another hemorrhagic stroke. Use and benefit in those with a history of thrombotic stroke is fairly well supported.
- If your 10-year cardiovascular risk is greater than 7.5%, which the risk calculator attached to these guidelines only goes up to the age of 79. So I joke, if I’m 79 and my risk is 30%, I then start a statin, and on my 80th birthday I can stop the statin, right? Does this mean that primary prevention in older adults 80 and higher is missing evidence? I think so, as has been the picture for some time.
The problem with the last recommendation, when cardiovascular risk is greater than 7.5%, is that the risk calculator may be flawed, or so say some experts.
Other considerations are that for older adults, or shall I say young-old adults up to age 75, the guidelines recommend use of statins for those with diabetes, but does this mean for older adults >75 with diabetes that statins are not recommended? I’m not certain what they are saying or if they just couldn’t find strong enough evidence in that age group, which doesn’t mean they are not beneficial.
Keeping this person-centered, I suggest that you review with your doctor the guidelines and the specifics of your situation to make an informed decision that best supports taking a statin, but at the right dose, and monitor for potential adverse effects, such as muscle pain, peripheral neuropathy, memory loss and diabetes.
Update: Nov 27, 2013: When using the risk calculator it appears that with increasing age there is a disproportionate increase in risk for a CV event (4% for a 55 y/o male vs. 27% for a 79 y/o male with the same low risk factors). The question I have is, will the addition of a statin eliminate all that increase in risk you’ve gained over the years? Probably not, yet it remains unknown. Also, to help with perspective, a significant number of people will still experience a stroke or heart attack while on a statin, and only one additional person will evade a CV event over 4-5 years as compared to the 6 or 7 out of 100 who are treated who do not.