According to an editorial, current guidance on lipid management in older adults is inconsistent: NICE recommends statins for primary prevention up to age 84, the European Society of Cardiology recommends treatment to age 65, and the American Heart Association up to age 75. It notes that both the American Heart Association and NICE recognise that trial evidence for those aged more than 75 is limited, yet NICE continues to recommend statins up to the age of 84 consistent with the upper age limit of the QRISK2 CVD risk calculator. For those with type 2 diabetes, NICE recommends statin prescription guided by a CVD risk calculation, whereas the American Heart Association recommends statins without risk calculation.
It adds that since age alone for those aged more than 75 is enough to cross the CVD risk threshold for primary prevention, the biggest challenge for clinicians is how to stratify risk among those aged more than 75 to inform shared decision making. It also notes that observational data have shown researchers and patients having differing views on the relative importance of morbidity and mortality Patients aged 65 or older prioritised reductions in myocardial infarction and stroke over avoiding death, in contrast with researchers and those younger than 65. Therefore in older patients expressing a preference for extending longevity, current evidence supporting statins for primary prevention remains limited but the balance is tilted in favour of statin prescription for a patient with preference for reduction in myocardial infarction or stroke, though the absolute risk reduction and number needed to treat to prevent a CVD event in older patients remains uncertain.