John E. Morley, MB, BCh

Disclosures

J Am Geriatr Soc. 2011;59(10):1955-1956. 

In This Article

Conclusion

Aristotle claimed that the highest level of wisdom was phronesis. Phronesis is basically the ability to discern the correct action when there is insufficient scientific evidence to determine the absolute truth. This is clearly the case for statins and older persons.

In persons aged 70 to 80 with documented coronary artery disease, the preponderance of evidence favors the use of statins. It appears that there is little difference in which statin to use, and as such, using the cheapest generic statin is recommended.[17] Evidence in this population of the benefit of lowering cholesterol to very low levels is lacking, and as such, a minimum dose of a statin is recommended. There is limited evidence to support its use in persons with dementia and in frail persons with multiple disease processes. The potential negative effects of polypharmacy should also be considered before adding a statin to an extensive pharmaceutical regimen.[18] Statins should possibly be withheld in persons with multiple falls, or at least an aldolase level should be measured along with a CPK level. Potential negative effects on depression should be considered. There is no evidence to support primary prevention even in the presence of the high total or LDL-C levels.

In persons aged 80 and older, there is, for practical purposes, no good evidence to use statins. Based on observational studies, the oldest-old may receive a statin if they have arteriographically documented coronary atherosclerosis. Persons aged 80 and older who are taking a statin should have their LDL size measured, and only if they have a preponderance of small, dense LDL should the statin be continued.

The International Association of Gerontology and Geriatrics, in concert with the World Health Organization, has suggested that drugs that are to be used in the older population should undergo double-blind randomized controlled trials in nursing home residents.[19] Such a trial is desperately needed to determine the utility of statins in frail older persons (with and without dementia).

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