High-Intensity Statin Therapy Is “Too Much,” Thus Not Indicated for Very Elderly Patients

Abstract

Purpose: Although moderate- to high-intensity statin therapy is increasingly recommended in cardiovascular disease patients, the efficacy and safety in elderly patients have not been proven clearly. Here, we compare the effect of various-intensity statins between elderly and very elderly patients. Methods: 43,870 patients over 65 years old who were treated with statins were screened using electronic medical record data. Results: We evaluated 451 patients in the elderly group aged 65–74 years and 159 patients in the very elderly group over 75 years old. Baseline cholesterol profiles were similar between the 2 groups, but the 10-year atherosclerotic cardiovascular disease (ASCVD) risk was significantly higher in the very elderly (20.9 ± 11.5% vs. 37.2 ± 13.6%, p < 0.001). The reduction rate of low-density lipoprotein (LDL) (–40.2 ± 21.3% vs. –39.3 ± 21.0%, p = 0.634) and the ratio of target LDL attainment (74.2 vs. 79.2%, p = 0.252) were similar between the 2 groups. Low-intensity statins showed comparable LDL cholesterol reduction with moderate-intensity statins both in the elderly and the very elderly groups. The 10-year ASCVD risk reduction was similar between the 2 groups (–3.5 ± 4.9% vs. –3.0 ± 8.4%, p = 0.480), but in the very elderly group, no different ASCVD reduction rate was shown in low- to high-intensity statins (p = 0.784). Only the elderly group showed a significant correlation (r = 0.112, p = 0.017) with LDL reduction and 10-year ASCVD risk. Interestingly, the incidence of adverse drug reaction (ADR) was higher in the very elderly group (4.4%) than in the elderly group (2.7%) and was more frequent in high-intensity statin therapy. Conclusion: The efficacy of statins in LDL reduction was similar between the elderly and very elderly population. However, the benefit of moderate- to high-intensity statins is limited considering potential ADR. Therefore, the stepwise intensification of statin therapy might be necessary for the very elderly in spite of the higher cardiovascular risk.

Comparative Analysis of High-Intensity versus Low-to-Moderate Intensity Statin Therapy in Patients Undergoing Rotational Atherectomy for Calcified Coronary Artery Disease

“…However, subsequent studies, including research involving Asian populations, have indicated no differences in clinical outcomes based on statin intensity [29][30][31]. One of these studies was conducted among Korean patients who underwent PCI with DES for angina between 2011 and 2015.…”

The Link between Magnesium Supplements and Statin Medication in Dyslipidemic Patients

“…In the elderly (>75 years of age) with clinically significant atherosclerosis and CVD, the advised therapy begins with moderate-intensity statins because of the increased side effects associated with high-intensity statins and a lower efficacy of metabolic mechanisms [ 84 ], although not all the studies show important rates of adverse age-related clinical events depending on the intensity of the statin [ 85 ].…”

“…Other side effects associated with statins have been reported in various case reports but they need more evidence data [ 84 , 85 , 86 , 87 ]. So far, lowering cholesterol drugs are not proven to increase malignancy, or neurological or respiratory symptoms [ 98 ].…”

Combined Lipid-Lowering Therapy in Elderly and Senile Patients

“…Известно, что по мере увеличения возраста отмечается умеренное увеличение площади под кривой плазменная концентрация-время, вероятно, всех статинов, что ограничивает возможности использования высоких доз статинов [16]. Так, по данным анализа медицинской документации, 43 870 пациентов старше 65 лет, получающих статины в рамках первичной или вторичной профилактики, более 70 % из них прини-мают статины в низких или умеренных дозах [18]. В свою очередь, у пациентов, получающих высокие дозы статинов, значительно чаще встречались побочные эффекты, особенно у пациентов старше 75 лет.…”