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Statins for Primary Prevention in Older Adults: Who Is High Risk, Who Is Old, and What Denotes Primary Prevention?

Susan J. Zieman, MD, PhD; and Pamela Ouyang, MBBS
[+] Article, Author, and Disclosure Information

From Johns Hopkins University School of Medicine, Baltimore, Maryland, 21224, and Johns Hopkins Bayview Medical Center, Baltimore, Maryland, 21224.

Potential Conflicts of Interest: None disclosed. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M10-0521.

Requests for Single Reprints: Pamela Ouyang, MBBS, Division of Cardiology, A1-East, Johns Hopkins Bayview Medical Center, 4940 Eastern Avenue, Baltimore, MD 21224; e-mail, pouyang1@jhmi.edu.

Current Author Addresses: Dr. Zieman: Carnegie 568, Johns Hopkins Hospital, 600 North Wolfe Street, Baltimore, MD 21287.

Dr. Ouyang: Division of Cardiology, A1-East, Johns Hopkins Bayview Medical Center, 4940 Eastern Avenue, Baltimore, MD 21224.

Ann Intern Med. 2010;152(8):528-530. doi:10.7326/0003-4819-152-8-201004200-00011
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Whether to treat older adults with statin medications for primary prevention of cardiovascular events remains a clinical conundrum. A number of observations with regard to increasing age stoke this dilemma: The association between elevated cholesterol levels and cardiovascular risk diminishes (1), risk-prediction tools (such as the Framingham risk score) become less accurate (23), supporting clinical trial data become limited, and the decreasing life expectancy versus time to medication benefit constantly shifts. Additional downsides of statins for older adults include medication cost, polypharmacy, and possible side effects. Conversely, age alone makes older adults inherently high risk and statins reduce cardiovascular events and death and may have other beneficial effects. Clinical trial data support secondary prevention of cardiovascular events with statins for persons 80 years or younger, but data are scant thereafter. As the number of persons 65 years or older rapidly increases, and more so the number of persons 85 years or older, this clinical question needs to be addressed.

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