It is unclear what the acceptable lower limit of LDL is, but a dose reduction should be considered if two consecutive LDL readings are 190 mg/dL, or diabetics aged 40-75. Thus, a decision to use statins should be individualized by considering risk factors such as high LDL (>160 mg/dL), family history of early ASCVD, high C-reactive protein levels (>2 mg/L), peripheral vascular disease (as shown by an ankle-brachial index 190 mg/dL, or if there is a concern for non- adherence.
The panel also recommended that high-intensity statins should be used if the low-density lipoproteins (LDL) level is ≥190 mg/dL or if the 10-year risk of an atherosclerotic cardiovascular disease (ASCVD) event is ≥7.5% (see 10-year risk calculator in References/Resources the age limit for use of the calculator is considered to be 79 years).įor patients >75 years, the evidence for using high-intensity statins to reduce ASCVD events is less strong. The panel recommended that high-intensity statin therapy (atorvastatin 40-80 mg or rosuvastatin 20-40 mg) should be given to patients ≤75 years of age who have a history of myocardial infarction, stable or unstable angina, coronary or other arterial revascularization, peripheral vascular disease, stroke, or transient ischemic attack. The 2013 recommendations from the Expert Panel of the American College of Cardiology (ACC) and the American Heart Association(AHA) provide a new framework for choosing initial statin therapy.
#Moderate intensity statin trial
There are currently no completed studies that include patients >85 years of age, though in December 2014, the STAREE trial was launched which is examining the use of atorvastatin 40 mg in healthy adults >70 years of age. Perhaps because of the resulting uncertainties about the safety and benefit of lipid-lowering therapy in older adults, statins have long been underused in this age group, even though older adults may derive the most benefit in terms of cardiovascular risk reduction.Īside from the SAGE and PROSPER trials which included patients aged 65-85 and 70-82 years, respectively, the majority of our data on statin use in older adults is derived from subset analysis of larger trials. While older adults face the largest risk for and burden of cardiovascular disease and events, they have been underrepresented in major clinical trials examining lipid-lowering therapy.
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