Reexamining Recommendations for Treatment of Hypercholesterolemia in Older Adults

The 2018 American College of Cardiology (ACC)/American Heart Association (AHA) guideline on the management of blood cholesterol recommends that “In adults 75 years of age or older with an LDL-C level of 70 to 189 mg/dL (1.7 to 4.8 mmol/L), initiating a moderate-intensity statin may be reasonable.”1 If this recommendation was interpreted to mean that all patients meeting these criteria should receive statin therapy, an estimated 18 million older adults2 could potentially be at risk for adverse effects related to statins, based on limited evidence of a benefit of statin treatment in this age group. According to the introduction to the primary prevention section of the guideline, “For patients >75 years of age, RCT evidence for statin therapy is not strong.” The guideline also cautions about using age as a dominant risk factor, stating, “One limitation on the pooled cohort equation when applied to individuals is that age counts as a risk factor and dominates risk scoring with advancing age. Age is a powerful population risk factor but does not necessarily reflect individual risk.”…

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