Primary Prevention Statins in Older Adults: Personalized Care for a Heterogeneous Population. Issue 3 (22nd January 2020)

• Record Type: Journal Article
• Authors: O'Neill, Deirdre; Stone, Neil J.; Forman, Daniel E.
• Is Part Of: Journal of the American Geriatrics Society. Volume 68:Issue 3(2020)
• Page Start: 467
• Page End: 473
• Publication Date: 2020-01-22
• Subjects: cholesterol -- statin -- coronary artery calcium; Geriatrics -- Periodicals; 618.97
• DOI: 10.1111/jgs.16330
• Languages: English
• ISSNs: 0002-8614

Abstract

Abstract : The 2018 American College of Cardiology/American Heart Association guidelines on the management of cholesterol acknowledge a lack of robust randomized clinical trial data to support routine use of statin therapy for primary prevention in adults older than 75 years. Shared decision making is emphasized because potential recommendations should reflect limitations of the current data, as well as heterogeneity of the older adult population, spanning the robust to the most frail. Although the National Institute on Aging recently funded PR agmatic EV aluation of EvENT s A nd B enefits of L ipid‐Lowering in OldE r Adults (PREVENTABLE), a trial to study benefits of statins in very old adults, data are not anticipated for 5 years. Thus interim guidance is essential. Furthermore, even when PREVENTABLE is completed, individual idiosyncrasies among older adults suggest that decisions for each patient will still need to be personalized, relative to their unique clinical situation. In this article, we present three case studies to highlight dynamics that commonly impact choices regarding statins in older adults. Details underlying shared decision making are also described including the evolving application of coronary artery calcium to inform this practice. J Am Geriatr Soc 68:467–473, 2020 Abstract : See related editorial by Shah et al . in this issue.