Here are answers to 4 FAQs on use, dosage, effectiveness, and appropriate statin selection in the elderly.

Do statins in elderly people decrease mortality?

In randomised trials, the effectiveness of statins in elderly people has been poorly discussed, but indirect evidence shows that older individuals may benefit from statins. However, the advantage can be attenuated in the elderly to the increased prevalence of severe comorbidities, such as HF, which are also present and do not benefit from statins.

Are statins safe in the old age group?

Elderly people are vulnerable to adverse experiences. The reduction in physiological reserve, increasing frailty, polypharmacy, and the presence of serious comorbidities are all leading to the rise in medication-related adverse effects. Although adverse effects can occur, in the elderly, statins are considered acceptable as the adverse effects are typically mild and seldom harmful.

What are the considerations for deciding dosage?

The dosage should mainly be driven by cardiovascular risk (as more potent statins have additional benefits). Careful consideration should be given to the restrictions in usage due to intolerance primarily linked to drug-drug interaction (DDI). However, in elderly frail people, physicians should consider refusing statins, which are unable to provide any benefit due to frailty or limited life expectancy of the patient.

Which statin can be used in older patients with polypharmacy?

Statin metabolism variations have therapeutic importance and can determine DDIs. Cytochrome P450 isoenzyme CYP 3A4 is the main catalyst for the metabolism of several drugs, including certain statins. Cometabolism by this enzyme is responsible for the most common drug interactions. With pravastatin, the lower risk of DDIs is seen because its metabolism is P450 independent, and with fluvastatin, which is metabolised by CYP2D9.

This is the fifth in the series on statins. Click on the following links to read the previous articles in the series.

Is it safe for patients with heart failure to use statins?

Can statins induce new-onset diabetes?

Can statins delay the loss of renal function?

Can liver dysfunction be triggered by statins?

Disclaimer- The views and opinions expressed in this article are those of the author's and do not necessarily reflect the official policy or position of M3 India.

The author, Dr. Monish S Raut is a Consultant in Cardiothoracic Vascular Anaesthesiology. His area of expertise is perioperative management and echocardiography with numerous publications in various national and international indexed journals.