The following is the summary of “Statins in Primary Prevention in People Over 80 Years”published in the January 2023 issue of Cardiovascular Disease by Marcellaud, et al.

The care of cardiovascular disorders in the elderly (≥80 years) needs specialized study to prevent a simple extrapolation of medical practice from younger groups. It is unclear whether statins are beneficial for primary prevention in this population. 3 complex issues need to be addressed: the role of hypercholesterolemia in mortality and major adverse cardiovascular events in subjects aged 80 and older, the effectiveness of statins in preventing cardiovascular events in this age group, and the safety and tolerance of statins in this population. 

The databases EMBASE, MEDLINE, the Cochrane Central Register of Controlled Trials, and Web of Science were searched, and articles published up through January 2021 were included in three systematic reviews. Only 29 of the initial 7,617 references were kept. Regarding the primary aim, 7 studies (10,241 participants) did not discover total cholesterol and low-density lipoprotein levels related to an increased risk of major cardiovascular events in the elderly. This objective included data from 16 studies with a total of 121,250 participants. 6  studies with a total of 14,493 participants revealed an association between higher levels and events, while 3 studies with 96,516 participants found the opposite, reporting a higher risk of severe adverse cardiovascular events in those with lower levels of cholesterol. Overall, the rate of major cardiovascular events did not appear to be significantly reduced in 8 studies (436,005 people) examining the effectiveness of statins. 

Finally, the most significant adverse effects in this sample were muscular, hepatic, and gastrointestinal diseases (9 studies, 217,088 individuals). These occurrences occurred at a higher rate than in younger generations. In conclusion, the benefit of statins in primary prevention for much older people is still being determined without solid evidence. Their dosing in this context should be decided on a case-by-case basis, in light of the individual’s current health, presence of any other conditions, risk factors, and anticipated lifespan. In addition, there must be targeted trials.