Should You Take A Statin If You Are Over 60? 

The Cholesterol Myth book concluded that treating the elderly with statin therapy had no benefit. They argued that people over the age of 60 should not attempt to lower their cholesterol. This flies in the face of every study we have discussed, as they all had participants over the age of 60 and they all benefited.

But let’s examine a study that looked at those aged 50 to 75.

Statins In Ages Age 50 to 75 Years

“Evaluation of Time to Benefit of Statins for the Primary Prevention of Cardiovascular Events in Adults Aged 50 to 75 Years”

The study found that adults 50 to 75 years of age have significant benefit from statin use for primary prevention. The exact opposite of what The Cholesterol Myth book concluded. It’s just not as sexy and no one is making up studies to sell you a book.

They found that for every 100 adults you treat with a statin for 2.5 years, you prevent 1 MACE event. So that means the NNT (number needed to treat) was 100.

https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2773065

Statins In Age Over 65

Another review looked at studies that included older adults to see if lipid lowering therapy made a difference or reduced risk. They found that lipid lowering therapy in those greater than age 65 showed tremendous risk reductions.

As you can see from the above chart, lipid lowering therapy conferred a 44% relative risk reduction in some trials, but the combined total relative risk reduction is that orange diamond at the bottom, showing a 25% relative risk reduction. You’ll notice that the lower the achieved LDL-C in the listed studies, the better the risk reduction.

From:
https://www.jacc.org/doi/10.1016/j.jacc.2023.08.005

Reductions In Risk Regardless Of Age

Another study from October 2023, looked at 65,000 people in the Journal of the American College of Cardiology also demonstrated significant reductions in risk regardless of age.

This was the chart from the study demonstrating significant reduction across all age groups.

Even if you were in the 80-84 age group, you had an almost 20% relative risk reduction for every 1 mmol/L reduction in LDL-C. Further, f you were above the age of 85 (extreme elderly), you had a 22% reduction in risk for every 1 mmol/L reduction in LDL-C. That's pretty impressive.

For each 1 mmol/L (38.6 mg/dL) reduction in LDL-C you had a 23% reduction in MACE in the elderly and for those who were younger.

It's great to live to 80+, but it's even better to not ever have a stroke or heart attack!

From:
https://www.jacc.org/doi/full/10.1016/j.jacc.2023.07.027

Is it ever too late to start statin or lipid lowering therapy?

No.

If your LDL-C was 135 mg/dL and you were to start on lipid lowering therapy at age 60, you would have a 27% reduction in MACE. If you were to start at age 50, you would have a 35% reduction in MACE. If you were to start at age 30, you would have a 52% reduction in cardiovascular event rates (MACE).

Next time someone asks you if it’s too late to start, you can show them this graph and reference this paper by the World Heart Federation.

From:
https://globalheartjournal.com/articles/10.5334/gh.1154 

Another study from December 2023 showed that initiating statin therapy in “frail” Veterans, above the age of 65, reduced all-cause mortality, CV mortality, and MACE events. Statin use was associated with a 39% reduction in all-cause mortality.

Study:
https://agsjournals.onlinelibrary.wiley.com/doi/10.1111/jgs.18700

Should You Start Statins After Age 75?

1. The "Official" Guidelines are Blurry Right now, the major medical organizations (like the USPSTF and the American Heart Association) do not have a hard "Yes" or "No" rule for starting statins in people over the age of 75. They call it a "weak recommendation," which essentially means: "Proceed with caution and decide on a case-by-case basis."

2. One Size Does Not Fit All - Because the guidelines aren't black and white, doctors are urged to look at the "whole person" rather than just the cholesterol number. Before prescribing to an older patient, we have to look at:

• Polypharmacy: Are you already taking too many other medications?
• Frailty: How strong is your body physically?
• Life Expectancy: Will you live long enough to see the 5-10 year benefits of the drug? The answer in today's modern world is probably yes if all else is well.

3. The New Findings (The Good News) These studies suggests that lowering LDL ("bad" cholesterol) does effectively prevent heart disease in older adults. This is a big deal because it hints that future guidelines might become more pro-statin for seniors.
4. The "But" (The Safety Warning) While the study showed benefits, it did not specifically test for safety or side effects in this age group. This is critical because older bodies process drugs differently (metabolism changes as we age), and older adults are more prone to side effects.

The Bottom Line for Patients

If you are over 75, lowering your cholesterol still helps your heart. However, the decision to start a pill needs to be a careful conversation with your doctor to balance that benefit against the risk of side effects and how many other medicines you are taking. If it was me, I would choose to take the meds and prevent a devastating heart attack or stroke. At age 75, you don't want to be debilitated.