Statin therapy for the octogenarian?

Cardiovascular risk increases progressively with age. Statins in octogenarians may therefore potentially bring about large reductions in absolute risk. Epidemiological studies, however, show that statin prescription declines with age and is lowest in the oldest patients with the highest cardiovascular risk. Reasons for low statin utilisation in the elderly include safety concerns, doubts about the utility of statin therapy in those of advanced age and a paucity of definite trial evidence supporting statin prescription in octogenarians. Some of the more recently completed statin outcome trials have randomised patients as old as 82 years. A meta-analysis of secondary prevention, with patients aged 65-82 years at randomisation, supported statin prescription in this age group, as statin therapy was associated with relative risk reduction similar to that observed in younger patients. A Swedish registry study showed improved survival in octogenarians prescribed a statin following hospitalisation with an acute myocardial infarction. Currently there is no definite evidence that statin therapy prevents or ameliorates cognitive impairment or dementia. Statin therapy should be considered in octogenarians at high cardiovascular risk, taking into account factors such as biological vs. chronological age, life expectancy, quality of life, risk of interaction with medications taken for co-morbidities and the ability of the patient to take the statin safely.