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Drug Insight: statin use in the elderly

Nature Clinical Practice Cardiovascular Medicine volume 3, pages 318–328 (2006)Cite this article

Abstract

The elderly represent a notable proportion of patients who present with myocardial infarction or acute coronary syndromes. This subgroup of patients also experiences a higher incidence of adverse outcomes than younger age-groups, and, therefore, has more to gain from effective, evidence-based therapies. The efficacy of statins in secondary cardiovascular disease prevention is firmly established. The starting of therapy soon after an acute coronary event has been shown to provide added benefit. Uncertainties about the effectiveness of statins in the elderly, however, have resulted in their underuse in this population. In this review we evaluate the evidence for statin use in this important and increasingly large group of patients.

Key Points

  • The efficacy and safety of 3-hydroxy-3- methylglutaryl coenzyme A reductase inhibitors (statins) have been established for primary and secondary cardiovascular disease prevention

  • The elderly have much to gain from statin therapy but these drugs are consistently underprescribed, partly because of under-representation of elderly patients in clinical trials

  • Risk: benefit ratios and cost-effectiveness data clearly support the widespread use of statins for secondary cardiovascular prevention in elderly patients

  • Data are limited on aggressive statin therapy after acute coronary syndromes in elderly people, but evidence suggests that an LDL-cholesterol target of <1.8 mmol/l (70 mg/dl) is reasonable

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Figure 1: Effects of pravastatin and placebo among patients aged 31–64 years and patients aged 65–75 years.
Figure 2: Relative and absolute reductions in rates of coronary heart disease, death and nonfatal myocardial infarction per mmol/l LDL-cholesterol reduction, after 5 years of statin therapy, in the Heart Protection Study and the Cholesterol Treatment Trialists' meta-analysis.

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Acknowledgements

We are grateful to C Nell and B Semb for secretarial assistance.

Author information

Authors and Affiliations

  1. research fellow in the Cardiology Division at Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA

    O Christopher Raffel

  2. Professor at the Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand

    Harvey D White

Authors
  1. O Christopher Raffel
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  2. Harvey D White
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Corresponding author

Correspondence to Harvey D White.

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Competing interests

Harvey D White has received research funding from Merck Sharpe & Dohme.

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Raffel, O., White, H. Drug Insight: statin use in the elderly. Nat Rev Cardiol 3, 318–328 (2006). https://doi.org/10.1038/ncpcardio0558

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