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Care of the Aging Patient: From Evidence to Action
September 17, 2014

Evaluation and Treatment of Older Patients With HypercholesterolemiaA Clinical Review

Author Affiliations
  • 1Geriatric Clinic, Department of Medicine, University of Helsinki, Helsinki, Finland
  • 2Institute of Health Sciences/Geriatrics, University and University Hospital of Oulu, Oulu, Finland
  • 3Helsinki University Central Hospital, Helsinki, Finland
  • 4Unit of Internal Medicine, North Karelia Central Hospital, Joensuu, Finland
  • 5Mehiläinen Airport Health Centre, Vantaa, Finland
  • 6Finnish Institute of Occupational Health, Lappeenranta, Finland
JAMA. 2014;312(11):1136-1144. doi:10.1001/jama.2014.10924
Abstract

Importance  Hypercholesterolemia is common among people older than 80 years. Substantial functional heterogeneity exists among older patients, and decision making for statin use differs in older patients relative to younger ones.

Objective  To discuss the presentation, modifying factors, and treatment of hypercholesterolemia (usually with statins) among persons older than 80 years.

Evidence Review  MEDLINE and other sources were searched from January 1990 to June 2014. Personal libraries and a hand search of reference lists from guidelines and reviews from January 2000 to June 2014 were also used.

Findings  No randomized clinical trials (RCTs) of statin or any other hypocholesterolemic medication included persons older than 80 years at baseline. Findings from 75- to 80-year-old patients enrolled in RCTs and information from observational studies support statin treatment for secondary prevention of atherosclerotic cardiovascular disease (ASCVD) and probably in patients with diabetes without ASCVD. Harms from statin drugs are not increased in older patients, so the use of these agents for primary prevention is possible. Because people older than 80 years are biologically heterogeneous with varying life expectancy, may have frailty or comorbid conditions, and may take multiple medications, the decision to treat with statins must be individualized.

Conclusions and Relevance  Ideally, treatment of hypercholesterolemia for patients at risk of ASCVD should start before they turn 80 years old. No RCT evidence exists to guide statin initiation after age 80 years. Decisions to use statins in older individuals are made individually and are not supported by high-quality evidence.

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