Statins in Very Elderly Adults (Debate)

Neil J. Stone, MD, MACP, FACC; Sunny Intwala, MD; Dan Katz, BA


J Am Geriatr Soc. 2014;62(5):943-945. 

In This Article


Musculoskeletal complaints are frequent in practice, and non-RCT data suggest that musculoskeletal conditions, arthropathies, injuries, and pain are more common in statin users than in similar nonusers.[7] Closer inspection of this population showed that the individuals in the study were predominantly simvastatin users (73%). Moreover, it was reported that approximately one-third used a maximal dose of a statin including simvastatin 80 mg/d. The Food and Drug Administration (FDA) has recommended that simvastatin 80 mg/d not be initiated because of a higher risk of musculoskeletal problems at this dose (including the usually rare rhabdomyolysis).[8] In older adults, this dose should not be used, given the availability of safer alternatives. Individuals with established ASCVD with nonspecific muscle symptoms who derive substantial benefit from statin therapy may prematurely stop statin therapy without considering a rechallenge or another statin. If muscular symptoms are moderate to severe or progressive, statin cessation to reevaluate a dosage change or switch to another statin or a nonstatin regimen is appropriate. Drug–drug interactions should be searched for and creatine kinase checked in these individuals. If thyroid-stimulating hormone levels have not been checked, it is appropriate, along with other clinically indicated testing. A retrospective cohort analysis of 18,778 individuals with statin-related adverse effects (most commonly musculoskeletal in nature) reported that 11,124 had statins discontinued at least temporarily. Of the 6,579 rechallenged with a statin over the subsequent 12 months, more than 90% were still taking a statin 12 months after the statin-related event.[9] This would suggest that, if a strong case can be made for statin therapy (a person with established ASCVD or, for example, those at high ASCVD risk because of diabetes mellitus, chronic renal disease (not hemodialysis), or familial hypercholesterolemia), the doctor and individuals may decide to try a lower statin dose or other appropriate statins in a systematic fashion. The strong benefit of statin therapy in those with established ASCVD must be considered carefully before statin therapy is rejected as an option.