Atherosclerotic
cardiovascular diseases (ASCVD) are the leading cause of death worldwide. High levels of total
cholesterol-and of
low-density lipoprotein cholesterol in particular-are one of the main risk factors associated with ASCVD.
Statins are first-line treatment for
hypercholesterolemia and have been proven to reduce major vascular events in adults with and without underlying ASCVD. Findings in the literature show that
statins reduce coronary and cerebrovascular morbidity and mortality in middle-aged people, but their benefits in older adults are not as well-established, especially in primary prevention. Furthermore, many particularities must be considered regarding their use in old subjects, such as age-related changes in pharmacokinetics and pharmacodynamics, comorbidities,
polypharmacy, and
frailty, which decrease the safety and efficacy of
statins in this population.
Myopathy and a possible higher risk of falling along with
cognitive decline are classic concerns for physicians when considering
statin use in the very old. Additionally, some studies suggest that the relative risk for coronary events and cardiovascular mortality associated with high levels of
cholesterol decreases after age 70, making the role of
statins unclear. On the other hand, ASCVD are one of the most important causes of disability in old subjects, so cardiovascular prevention is of particular interest in this population in order to preserve functional status. This review aims to gather the current available evidence on the efficacy and safety of
statin use in very old patients in both primary and
secondary prevention.