What the guidelines do not say: statin non-benefit groups.

The 2013 American College of Cardiology/American Heart Association guidelines for management of low-density lipoprotein cholesterol (LDL-C) to reduce atherosclerotic cardiovascular disease (ASCVD) risk identified four groups of adults (40-75 years of age) with significant evidence for benefit from statin therapy: presence of clinical ASCVD or diabetes, age ≥21 years and LDL-C >190 mg/dl, and 10-year risk of hard ASCVD events ≥7.5 % as determined by the new Cardiovascular Risk Calculator. However, clinicians are faced daily with at-risk patients who do not clearly match one of these statin-benefit groups. Understanding the limitations of available evidence and awareness of additional published guidelines for statin non-benefit groups will help practitioners make personalized decisions with patients and inform the clinician-patient discussion regarding potential risks and benefits of statin therapy.

Statin drugs: reducing cardiovascular risk in older adults.

Dyslipidemia is one of the most modifiable risk factors in preventing heart disease. Evidence demonstrates that the process of atherosclerosis, a result of dyslipidemia, begins in young adults. Initiating statin therapy has been shown to reduce the risk of cardiovascular events and mortality. Determining the right statin medication and dose for an older adult based on national guidelines can be challenging, as multiple factors must be considered in this decision. When initiating statin therapy, clinicians should determine the appropriate percentage of reduction in low-density lipoprotein cholesterol needed to achieve the target goal. Additionally, when changing from one cholesterol-lowering medication to another, knowledge of equivalent dosing is important. Generally, statin drugs are well tolerated with a good safety profile in older adults but are underused in this patient population. Issues such as existing comorbid conditions, polypharmacy with the potential for drug-drug interactions, impaired drug metabolism, and decreased functional status can contribute to adverse events and increase the frequency of myalgias and less frequently, hepatotoxicity. Clinicians prescribing statin therapy for older adults need to remain current on advances in research regarding potential interactions and contraindications within this drug class.