University of Oulu

Strandberg, T.E. Curr Atheroscler Rep (2019) 21: 28.

Role of statin therapy in primary prevention of cardiovascular disease in elderly patients

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Author: Strandberg, Timo E.1,2,3
Organizations: 1University of Helsinki, PO Box 340, FIN-00029 Helsinki, Finland
2Center for Life Course Health Research, University of Oulu, Oulu, Finland
3Helsinki University Hospital, Helsinki, Finland
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 0.3 MB)
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Language: English
Published: Springer Nature, 2019
Publish Date: 2019-07-31


Purpose of Review: Hypercholesterolemia and statin treatment are nowadays common among people older than 75 years, but clinical heterogeneity in this increasing age group is wide, and treatment decisions may differ from those in younger patients. Aim is to discuss the presentation, modifying factors, and treatment decisions of hypercholesterolemia (usually with statins) in older persons and focusing on primary prevention.

Recent Findings: There are no randomized controlled trials in persons older than 80 years at baseline. Randomized controlled trial findings in younger patients and 75+ subgroups and in observational studies support treatment in secondary prevention of atherosclerotic cardiovascular disease (ASCVD), but trial evidence in primary prevention is less clear. Available data do not imply specific harms in older patients, and, therefore, also, judicious primary prevention is possible. However, persons older than 75 years are biologically a very heterogeneous group with frequent frailty, comorbid conditions, and multiple concomitant drugs. All these, as well as personal preferences, must be taken into account in treatment decisions.

Summary: Statin treatment is only one way to prevent ASCVD in older people. Treatment of hypercholesterolemia should be started far before 75–80 years, and there is no need to discontinue statin treatment due to chronological age alone. After 75 years, treatment should be started in patients with ASCVD and judiciously in primary prevention. Like all prevention, statin treatment should be discontinued when palliative treatment is started. Ongoing and planned trials in 70+ individuals will give more information about primary prevention in older persons.

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Series: Current atherosclerosis reports
ISSN: 1523-3804
ISSN-E: 1534-6242
ISSN-L: 1523-3804
Volume: 21
Issue: 8
Article number: 28
DOI: 10.1007/s11883-019-0793-7
Type of Publication: A2 Review article in a scientific journal
Field of Science: 3121 General medicine, internal medicine and other clinical medicine
Funding: Funding received is not directly to this review. Dr. Strandberg's research has been supported by the University Central Hospital of Helsinki (TYH 2014245; 2015211), the Gustav V och Victoria Frimurarestiftelse, and the Academy of Finland (grant number 311492).
Copyright information: © The Author(s) 2019. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made