Primary Prevention With Statins in the Elderly

Martin Bødtker Mortensen, MD, PHD; Erling Falk, MD, DMSC


J Am Coll Cardiol. 2018;71(1):85-94. 

In This Article

Abstract and Introduction


The burden of atherosclerotic cardiovascular disease (ASCVD) in high-income countries is mostly borne by the elderly. With increasing life expectancy, clear guidance on sensible use of statin therapy to prevent a first and potentially devastating ASCVD event is critically important to ensure a healthy aging population. Since 2013, 5 major North American and European guidelines on statin use in primary prevention of ASCVD have been released by the American College of Cardiology/American Heart Association, the UK National Institute for Health and Care Excellence, the Canadian Cardiovascular Society, U.S. Preventive Services Task Force, and the European Society of Cardiology/European Atherosclerosis Society. Guidance on using statin therapy in primary ASCVD prevention in the growing elderly population (>65 years of age) differs markedly. The authors discuss the discrepant recommendations, place them into the context of available evidence, and identify circumstances in which uncertainty may hamper the appropriate use of statins in the elderly.


The short-term risk of atherosclerotic cardiovascular disease (ASCVD) increases with age, with the highest incidence rates, number of events, prevalence, and treatment costs in the elderly population. Given the increasing size of this population, it is critically important that guidelines provide clear recommendations for appropriate use of interventions of proven efficacy to reduce the burden of ASCVD in the elderly. Statin therapy represents a substantial potential for safe, effective, and inexpensive primary prevention of ASCVD in elderly individuals (here defined as individuals >65 years of age), as statins have been shown to be generally well tolerated and improve ASCVD outcome across a wide range of population characteristics. However, this potential for meaningful benefits of preventive statin therapy in elderly people is inconsistently utilized in existing guidelines in Europe and North America, as described in this review.