Statins in Very Elderly Adults (Debate)

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

Disclosures

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

In This Article

Memory

The FDA performed a comprehensive review of observational and RCT data on statins and cognition and found rare cases of reversible, ill-defined memory loss or impairment in individuals aged 50 and older, with variable time to onset of symptoms since statin initiation.[8] The cases did not appear to be associated with fixed or progressive dementia, such as Alzheimer's disease. The review did not find an association between the adverse event and the specific statin, the age of the individual, the statin dose, or concomitant medication use. Thus, cognitive changes associated with statin use are not common, and statin use does not lead to clinically significant cognitive decline. Thus, if cognitive problems occur, individuals should review exogenous (especially other medications), systemic, and neurological causes with their physician before they assume that the cause is statin therapy.

In summary, there are important reasons to recommend statin therapy in individuals aged 85 and older who have established ASCVD. The high benefit-to-risk ratio that RCTs have found in individuals just a few years younger does not necessarily extinguish once one turns 85. In addition, in individuals who are at high risk but have not had a heart attack or stroke, such as those with diabetes mellitus or chronic renal failure (but excluding hemodialysis), in whom benefit in younger individuals significantly exceeds risks, statins can be considered, but polypharmacy, nonadherence, drug–drug interactions, and individual preference are strong reasons for shared decision-making with each individual. The decision to treat or not treat should always start with a careful review of likely benefits and the potential for safety risks. Thoughtful, evidence-based prescribing is emphasized in the 2013 cholesterol guidelines.[10]

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