Statins are drugs that lower your cholesterol. But if you are age 75 or older and you haven’t had symptoms of heart disease, statins may be a bad idea. Here’s why: Adults age 75 and older may not need statins.
Can you just stop taking a statin?
Stopping statin treatment can be dangerous for certain people, especially those who have a history of stroke, heart attack, or stenting. A 2017 study investigated whether quitting or reducing...
Should statins be taken with or without food?
When it comes to taking statins on an empty stomach, most professionals agree it is harmless. In fact, taking cholesterol medication with food could reduce risk of side effects. A study led by Doctor Richard Kim, a scientist at Lawson, found that eating food when taking the medication rosuvastatin can reduce the risk of side effects.
Should everyone over 65 take a statin?
In terms of preventing death from any cause, however, statins did not have an effect, the researchers said. Despite the new findings, Perrone-Filardi doesn't think everyone over 65 should be taking statins. The patients who benefit are those with a high risk for cardiovascular disease, he said. "The problem is that age is one of the main risk factors for cardiovascular disease, so it's difficult to detect among a population of old people who are the patients at very high cardiovascular risk ...
Should you be taking statins after age 75?
Statins are drugs that lower your cholesterol. But if you are age 75 or older and you haven’t had symptoms of heart disease, statins may be a bad idea. Here’s why: Adults age 75 and older may not need statins. Many older adults have high cholesterol. Their doctors usually prescribe statins to prevent heart disease.
At what age should you discontinue statins?
Do not start a statin in patients ages ≥ 75 years who do not have known vascular disease or type 2 diabetes; start or continue a statin in all patients ages 75 to 84 with type 2 diabetes to prevent cardiovascular events and mortality; and start or continue a statin in patients ages > 75 years who have known vascular ...
Are statins effective after age 75?
Another consideration for this study is that while analyzing medical records for a large population can provide evidence of a drug's benefit, only a well-designed clinical trial can provide definitive evidence that statin therapy is safe and effective in adults 75 and older.
Should I take statins over 70?
Statins should be taken with caution if you're at an increased risk of developing a rare side effect called myopathy, which is where the tissues of your muscles become damaged and painful. Severe myopathy (rhabdomyolysis) can lead to kidney damage. Things that can increase this risk include: being over 70 years old.
Can you ever stop taking statins?
It's possible for some people to stop taking statins safely, but it can be especially risky for others. For instance, if you have a history of heart attack or stroke, it's not recommended that you stop taking these drugs. This is because you're more likely to have another such problem when you discontinue statins.
What is the safest statin for elderly?
Atorvastatin or fluvastatin are usually recommended because there is no need to adjust the dose according to the glomerular filtration rate [28]. In patients without diagnosed atherosclerotic cardiovascular disease, it is indicated a moderate dose of statin, such as atorvastatin 20 mg daily [28].
Why should over 70s not take atorvastatin?
Statins also have potential side effects for older adults, such as muscle pain or weakness, which can contribute to frailty. “And there's an association for increased cognitive dysfunction in older people who take statins,” Amato said. “These side effects could lead to falls, injuries, and hospitalizations.”
Do most cardiologists take statins?
What a Cardiologist Wants You to Know. About 35 million people take statins in the United States, but research says only 55% of those who are recommended to take a statin are taking one.
What can I take instead of statins to lower cholesterol?
7 cholesterol-lowering alternatives to statinsFibrates. Mostly used for lowering triglyceride levels in patients whose levels are very high and could cause pancreatitis. ... Plant stanols and sterols. ... Cholestyramine and other bile acid-binding resins. ... Niacin. ... Policosanol. ... Red yeast rice extract (RYRE) ... Natural products.
Is there a link between statins and dementia?
The effects of statins may not only be affecting stroke risk, but may also be preventing microvascular infarcts that lead to dementia without an acute stroke. Statins have been linked with reduced risk of all-cause dementia and even Alzheimer's disease as well.
What is a healthy cholesterol level by age?
Optimal rangesAge and sexTotal serum cholesterolTriglyceridesall aged 19 years and younger170 mg/dl at mostless than 150 mg/dlfemales aged 20 years and older125–200 mg/dlless than 150 mg/dlmales aged 20 years and older125–200 mg/dlless than 150 mg/dl
What are the side effects of stopping statins?
If you stop taking your statin medication, like atorvastatin (Lipitor), you could have a higher risk of heart problems, including heart attack and stroke. Your healthcare provider may recommend stopping your statin if you have serious side effects.
Do statins clear the arteries of plaque?
Statins help lower low-density lipoprotein (LDL) cholesterol, also known as “bad” cholesterol, in the blood. They draw cholesterol out of plaque and stabilize plaque, Blaha says.
Should all seniors take statins?
Gregg Fonarow, a spokesman for the American Heart Association. Guidelines in the United States recommend statin therapy for primary prevention in men and women regardless of age. The guidelines from the European Society of Cardiology, however, do not provide recommendations for statin use in older people, Fonarow said.
What are the new guidelines for statins?
From the 2021 ESC guidelines, adults 40 to 49 years are eligible for statins if their 10-risk ASCVD risk is 7.5% or greater (class I recommendation). For those aged 50 to 69 years, statins are a class I recommendation if they have a 10-year risk of 10.0% or greater.
Is there a link between statins and dementia?
The effects of statins may not only be affecting stroke risk, but may also be preventing microvascular infarcts that lead to dementia without an acute stroke. Statins have been linked with reduced risk of all-cause dementia and even Alzheimer's disease as well.
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The Side Effects of Statins
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How old do you have to be to take statins?
Guidelines issued in 2013 by the American Heart Association also recommend statins for the general population up to age 75 – people in good health with no history ...
Do statins lower cholesterol?
Statins have been shown to lower cholesterol, reducing plaque that accumulates in blood vessels. The New York Times recently addressed the topic of people over age 75 taking statins for the prevention of heart disease.
How old do you have to be to take statins?
The U.S. Preventive Services Task Force recommends low- to moderate-dose statins in adults ages 40 to 75 who have one or more risk factors for heart and blood vessel disease and at least a 1 in 10 chance of having a cardiosvascular disease event in the next 10 years.
How do statins work?
By Mayo Clinic Staff. Statins are drugs that can lower your cholesterol. They work by blocking a substance your body needs to make cholesterol. Lowering cholesterol isn't the only benefit associated with statins.
What is the LDL cholesterol level for a diabetic?
People who have diabetes. This group includes adults 40 to 75 who have diabetes and an LDL cholesterol level between 70 and 189 mg/dL (1.8 and 4.9 mmol/L), especially if they have evidence of blood vessel disease or other risk factors for heart disease such as high blood pressure or smoking.
What is the best cholesterol level for a heart attack?
Low-density lipoprotein (LDL) cholesterol. Aim to keep this "bad" cholesterol under 100 mg/dL, or 2.6 mmol/L. If you have a history of heart attacks or you're at a very high risk of a heart attack or stroke, you may need to aim even lower (below 70 mg/dL, or 1.8 mmol/L).
What is the risk of a heart attack in 10 years?
People who don't have heart or blood vessel disease, but have one or more cardiovascular disease risk factors and a higher 10-year risk of a heart attack. This group includes people who have diabetes, high cholesterol or high blood pressure, or who smoke and whose 10-year risk of a heart attack is 10% or higher.
How to reduce risk of heart disease?
To reduce your risk: Quit smoking and avoid secondhand smoke. Eat a healthy diet rich in vegetables, fruits, fish and whole grains and low in saturated fat, trans fat, refined carbohydrates and salt.
Can you take statins if your cholesterol is high?
If your cholesterol — particularly the LDL ("bad") type — stays high after you make healthy lifestyle changes, statins might be an option for you.
How many cardiovascular events can be prevented by statins?
The researchers estimated that between 41,000 and 63,000 cardiovascular events would be prevented over a 10-year period by adopting the ACC/AHA guidelines compared to the previous guidelines.
Why do doctors prescribe statins?
Doctors may prescribe statins along with lifestyle changes to prevent or control cardiovascular disease. Purestock/Thinkstock. Atherosclerosis arises when fat, cholesterol, and other substances accumulate along artery walls and form a sticky buildup known as plaque.
What is the recommended LDL cholesterol level for ASCVD?
Among the recommendations was that people 40 to 75 years of age without clinical ASCVD and diabetes should take statins if they have an LDL cholesterol level of 70 to 189 mg/dL and an estimated 10-year ASCVD risk of 7.5% or more. The guidelines also included methods for making this risk estimate.
Is 7.5% a good risk threshold for statins?
The team found that the health benefits conferred by the current ASCVD risk threshold of 7.5% or higher were worth the incremental costs, according to commonly accepted “willingness-to-pay” public health standards. Lowering the threshold for statin treatment to 3% or 4% could avert another 125,000 and 160,000 cardiovascular events, respectively. Depending on assumptions about benefits and risks, these risk thresholds might also be considered cost-effective options. These estimates can help inform future decisions about balancing costs with quality years of life.
Is cholesterol treatment cost effective?
Two studies found that recent cholesterol treatment guidelines are a cost-effective way to prevent cardiovascular disease. The results suggest that it might be cost effective to lower the threshold for treatment with statins even further. Doctors may prescribe statins along with lifestyle changes to prevent or control cardiovascular disease.
How much lower chance of death from statins?
Similarly, an Israeli study, also published in 2019, in the Journal of the American Geriatrics Society, found that older people who adhered to their statin prescription had a 34 percent lower chance of an early death from any cause than those who stopped taking the drug.
How old do you have to be to have diabetes?
You are 40 to 75 years old with diabetes. You are 40 to 75 years old with a high risk of developing heart disease or stroke and have an LDL cholesterol level of 70 mg/dL or higher. According to the guidelines, after age 75 you should have a workup with your doctor and a discussion of risks and benefits. That's due to a lack of studies assessing the ...
Can you take statins over 75?
While all those benefits sound good, doctors may hesitate to prescribe this type of drug for people over 75 in the absence of clear-cut guidelines from the American College of Cardiology and the American Heart Association. Those state that you should take a statin if:
Do statins help older people?
A slew of recent studies have shown that statins may have significant benefits in older age groups. “Your physiology doesn't suddenly change when you turn 75 years of age,” says Steven Nissen, M.D., chair of cardiovascular medicine at the Cleveland Clinic.
Can you tweak statins?
If statin side effects become an issue, the prescription can often be tweaked . “For most people who say that they're statin intolerant, there's usually an option,” says Orkaby, who adds that there are some that are considered lower or moderate intensity. “It's finding the sweet spot of what works for every patient.".
Can older people take statins?
On the other hand, older patients are more likely to be on multiple medications that can interact with statins. And there's some evidence that this age group may be more prone to statin side effects, such as muscle pain, an increased risk of diabetes, and liver problems.
Is it bad to be over 75?
“About 1 in 3 Americans will ultimately die from cardiovascular disease,” Lewis says. “So everyone over 75 is at high risk.”. On the other hand, older patients are more likely to be on multiple medications that can interact with statins.
How to stop statins?
Talk with your doctor. If you want to stop taking your statin for any reason, talk with your doctor . If your doctor thinks it’s safe for you to consider changing your statin usage, they can help guide you. Reducing your dosage, adding supplements, or stopping the drug altogether might all be options.
What to do before stopping statins?
Your doctor may suggest that you implement certain lifestyle changes before stopping the statin, or directly in place of the drug. These changes might include adopting an exercise program or modifying your diet. For example, the AHA suggests following a Mediterranean diet or vegan diet.
What is the best cholesterol medication?
ezetimibe, another cholesterol medication. a fibric acid supplement such as fenofibric acid, which can lower LDL levels and increase HDL levels. a slow-release niacin supplement, which can lower LDL levels, increase HDL levels, and lower triglyceride levels.
What to take for high cholesterol?
For instance, the American Heart Association (AHA) recommends the following options for people with high cholesterol who cannot take statins: 1 ezetimibe, another cholesterol medication 2 a fibric acid supplement such as fenofibric acid, which can lower LDL levels and increase HDL levels 3 a slow-release niacin supplement, which can lower LDL levels, increase HDL levels, and lower triglyceride levels
How to lower cholesterol?
Lowering your cholesterol levels through diet, exercise, or weight loss could eliminate your need to take statins or other cholesterol medications . If you can do that, that’s great! Reducing your cholesterol levels in this way can help reduce your overall risk of a heart attack, stroke, or blocked arteries while allowing you to take one less medication.
What are some medications that lower cholesterol?
Popular statins include atorvastatin (Lipitor), rosuvastatin (Crestor), and simvastatin (Zocor). Statins work in two ways. First, they stop the production of cholesterol in your body. Second, they help your body reabsorb the cholesterol that has built plaques in your ...
Can you take statins for years?
Many people take statins for decades without having any side effects or issues. For those individuals, the medications can be a very effective form of treatment and prevention for cholesterol problems. Others may not have the same experience with statins. People who decide to quit taking statins may have several different reasons for doing so.
Why are statins important for older people?
There are reasons to believe that statins could have significant benefits in this age group. Advanced age is an important risk factor for cardiovascular events—80% of deaths from coronary heart disease occur in people over the age of 65. 6 If statins had similar relative efficacy in older patients as in younger patients, the absolute population benefits would be considerable. The patient described above with an estimated 30% 10-year ASCVD risk (i.e., risk of a fatal or non-fatal myocardial infarction [MI] or stroke) could have that risk cut to 24% based on a 20% relative risk reduction, which could be achieved with a mild-to-moderate-intensity statin. Simultaneously, there are several reasons to question the efficacy of statins in older adults. For example, in patients over the age of 75, low total cholesterol levels have been paradoxically associated with increased mortality, 7 although this may be due to confounders such as chronic illness, malnutrition, and frailty. 8 Another question is whether statins have sufficient time to exert beneficial effects (i.e., regression of atherosclerosis) in older individuals who have limited life expectancies and may already have a large atherosclerotic disease burden. Pleotropic effects may confer short-term benefits (e.g., plaque stabilization, reduced inflammation, reversal of endothelial dysfunction, decreased thrombogenicity), 9 although clinical trials have generally demonstrated that tangible clinical benefits (e.g., reduced event rates) do not occur until between six months and two years. 10
How effective are statins for prevention?
In patients under the age of 75, the efficacy of statins for primary prevention is well-established on the basis of multiple randomized trials, which have found that they reduce the relative risk of major vascular events by 20-30%. 3,4 The relative benefits of statins are consistent across multiple subgroups and similar for patients at both high and low risk for cardiovascular events; therefore, the absolute benefits of statins are greatest for high-risk patients. This forms the basis of the ACC/AHA recommendations on statins for primary prevention—namely, that statins are indicated for patients between 40 and 75 years of age with diabetes, LDL greater than 190, or a 10-year ASCVD risk of greater than 7.5%. While it has been estimated that 97% of individuals between 65 and 75 years of age meet criteria for a statin by these guidelines, 5 there is no specific recommendation for adults over the age of 75 due to their under-inclusion in pivotal clinical trials.
Why is shared decision making important for older adults?
Shared decision-making with older adults is a key component of patient-centered care, and is especially important in an area where the evidence is not entirely clear. For medications such as statins, the potential harms as well as the benefits of therapies must be considered. Advanced age is associated with decreased metabolism of drugs through multiple mechanisms including lower hepatic and renal clearance, decreased serum albumin, increased fatty tissue volume, and altered chemoreceptor sensitivity. 16 There is an increased risk of both medication-related adverse effects as well as drug interactions in a population where polypharmacy is the norm.
Is statin overutilized?
In summary, statins are probably both under- and over-utilized in older adults. For example, it is estimated that only 40-60% of patients over 65 are prescribed a statin after an acute MI; 24 conversely, a recent study found that 30% of patients with a cancer diagnosis were dispensed a statin within 30 days of dying. 25 For primary prevention, treatment recommendations should be individualized and take into account multiple factors including cardiovascular risk, life expectancy, frailty, comorbid conditions, and potential drug interactions. Involving patients in shared decision-making is key. In our patient, assuming she is otherwise in good health, she could very well experience a cardiovascular benefit given her functionality and relatively low burden of medications and comorbidities. If we initiate a low-to-moderate-intensity statin, close monitoring for adverse effects, medication changes, and development of comorbid illnesses is key as the risk/benefit profile may change over time.
Is statin safe for liver?
Data from statins in randomized trials in patients up to 80 years of age have shown that statins are generally safe and well-tolerated. 17,18 Severe liver injury is very rare, although mild elevations of liver function tests may occur. Muscle damage is another concern, although clinically significant myonecrosis (defined as a serum creatine kinase elevation of greater than ten times normal with symptoms) occurred in less than 0.5% of patients and has mainly been seen in patients on high doses of simvastatin, 19 and in the context of drug interactions, particularly those that inhibit the CYP3A4 system (e.g., cyclosporine, macrolides, azole antifungals) or independently cause myopathy (e.g., fibrates). 20 Statins that are not metabolized through the CYP3A4 system (pravastatin, fluvastatin, and rosuvastatin) may have a lower risk of interactions with commonly prescribed medications.
How long do you have to be on statins to prevent a stroke?
In the case of statins, researchers calculate 28 people with existing heart disease or who had had a stroke would need to be treated for five years to prevent one death, a figure low enough to warrant treatment.
How much does statin reduce cardiovascular events?
To complicate things further, pooling results of two of these trials finds statins reduce cardiovascular events in people aged under 65 years (by about 25%), 65-70 years (by about 50%) and over 70 years (by about 25%).
Why don't doctors prescribe cholesterol medicine?
Doctors don’t prescribe this so commonly to lower cholesterol nowadays because it has been replaced by stronger statins. Second, by the end of the study many people in the statin group had stopped their treatment while people in the usual care group had started treatment, either on pravastatin or another statin.
What is the most commonly used cholesterol lowering medication in Australia?
Statins are the most commonly used cholesterol lowering medications in Australia. In 2010-2011 they were taken by 2.6 million Australians with 16 million scripts dispensed from June 2011 to June 2012. They are prescribed to lower blood lipid levels and so reduce people’s chances of heart disease, including stroke, and to prolong life.
What are the best ways to reduce the risk of heart disease?
This discussion should take into account a person’s preference for statins and other measures to reduce their risk of heart disease, include having a healthy diet, being physically active and stopping smoking.
Does atorvastatin lower cholesterol?
Different statins reduce bad cholesterol to different extents. For example, atorvastatin and rosuvastatin produce larger reductions in bad cholesterol per milligram of drug than a different statin, pravastatin ( about 50% vs 30% ).
Do statins help with stroke?
The benefits of healthy older people taking statins to prevent heart disease and stroke needs to be balanced with the risk of side effects. from www.shutterstock.com.
