The Elderly

Question 11:

The 2013 ACC/AHA cholesterol guidelines are based on a large body of evidence that supports secondary prevention at which statin dose intensity in patients 75 years of age and older with clinical ASCVD?

  1. Low-intensity
  2. Moderate-intensity
  3. High-intensity

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Think carefully if you are considering a statin in the elderly… You may want to consider a statin in the elderly sometimes…
Statin therapy should be used with caution in patients over 75 years old, even with those with established ASCVD, particularly if using multiple other medications, medications that alter drug metabolism. There is very little evidence to guide treatment recommendations for patients over the age of 75. There is no established risk calculator or assessment tool available, though in certain patients you may consider extrapolating their risk from the standard calculator inputting age of 75.
The use of statins for primary prevention in patients >75 should be done with caution, taking into account patient preference, longevity, clinical priorities, and safety. Expert opinion is that statin therapy should be used in patients over 75 years old with established, clinical ASCVD (E).
Consideration should be given to polypharmacy and individual determination of the cost / benefit of a preventive medication. Expert opinion is that statin therapy can be considered in diabetic patients over 75 years old (E).
In older adults, a determination of life expectancy (useful tool is ePrognosis) should be made as expert opinion has stated that a preventive medication should not be given for life expectancy < 5 years. There is no reason to stop statin therapy in an elderly patient already tolerating these drugs.
In all adults over 75, executive function should be ascertained before prescribing any medication, in order to determine the patient’s ability to comply with the medication regimen.

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