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Editorials |21 April 2015

Cost-Effectiveness of Statins in Older Adults: Further Evidence That Less Is More

Michael W. Rich, MD

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Author, Article, and Disclosure Information
  • From Washington University School of Medicine, St. Louis, Missouri.

    Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M15-0535.

    Requests for Single Reprints: Michael W. Rich, MD, Professor of Medicine, Cardiovascular Division, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8086, St. Louis, MO 63110; e-mail, mrich@wustl.edu.

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One of the most common conundrums faced by primary care clinicians, geriatricians, and cardiologists is whether to prescribe statins for primary prevention of atherosclerotic cardiovascular disease (ASCVD) in older adults. The problem is that the many randomized clinical trials that have evaluated statins in a broad spectrum of patients have included few older adults typical of those seen in clinical practice. Accordingly, the 2013 American College of Cardiology/American Heart Association (ACC/AHA) Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults focuses almost exclusively on persons aged 21 to 75 years and provides only 2 paragraphs addressing those older than 75 years (1 each for primary and secondary prevention) (1).
At first glance, simply applying findings from younger populations to older adults might seem reasonable in the absence of evidence to the contrary. After all, the incidence and prevalence of ASCVD increase progressively with age (2); the majority of deaths attributable to ASCVD occur in older adults (3); and the potential benefit of statins, in absolute terms, is at least as great in older persons as in younger ones. Unfortunately, this view fails to consider several key factors that fundamentally alter the benefit–risk relationship of statins as people age. First, the importance of cholesterol as a risk factor for ASCVD decreases with age, and epidemiologic data suggest that higher cholesterol levels are associated with increased survival in persons aged 85 years or older (4). Second, older adults seem...
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Rich MW. Cost-Effectiveness of Statins in Older Adults: Further Evidence That Less Is More. Ann Intern Med. 2015;162:590–591. doi: 10.7326/M15-0535

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Published: Ann Intern Med. 2015;162(8):590-591.

DOI: 10.7326/M15-0535

3 Citations

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