August 21, 2016
Although cholesterol lowering medication clearly reduces heart attacks and strokes, little has been published about its’ effectiveness for patients over 80 years old. Current use focuses on “primary prevention” (prevent the initial occurrence of a heart attack or stroke) or “secondary prevention” (prevent a recurrence of disease).
In the United States, the American College of Cardiology states the evidence is not entirely clear for patients 80+ years old, and recommends individual doctor-patient discussions. The Choosing Wisely campaign promotes the concept of avoiding lipid lowering medications in persons with a limited life expectancy (< 5 years). In Australia, the NPS recommends against cholesterol med use in patients over 80 years’ age. They state, “the limited available evidence does not support an effect of lipid-lowering treatment in this population.”
A recent publication evaluated cholesterol medications in older individuals. A chart review of 1,262 hospitalized patients with heart attack, unstable angina or chronic heart disease found 72% of patients were discharged on cholesterol medication and 28% were not. Subsequent evaluation found no significant difference in all-cause mortality after three years, whether medication was used or not.
What does this mean to folks over 80 years’ age, who now take cholesterol medication? Discuss the potential risks and benefits of continued cholesterol medication with your doctor – whether for primary or secondary prevention. Please do not stop cholesterol medication without discussion with your physician. Factors to review include cost (minimal for widely available potent generics like atorvastatin), side effects (muscle aches, slight increased risk diabetes or memory loss), and benefit (possible improved quality of life via fewer heart attacks, no reduction in all-cause mortality, no clear conclusion at present).