This is definitely a topic worthy of discussion but I would point out that Rita Redberg has been opposed to any use of statins in primary prevention and therefore quite an outlier.
In my practice, I do a fair amount of deprescribing statins in the elderly. I have a very low threshold for initiating a trial of temporary statin cessation if there is any question that a patient’s symptoms could be statin-related.
The older the patient, the higher the bar for initiating statins and I think in all patients a search for subclinical atherosclerosis (coronary calcium scan or vascular ultrasound) helps inform the decision.
"A promising approach to personalize treatment in elderly people is “derisking” by use of negative risk markers (i.e., absence of coronary artery calcification) to identify those at so low risk that statin therapy may safely be withheld . In the BioImage study of elderly individuals, for example, absence of coronary artery calcification was prevalent (≈1 of 3) and associated with exceptionally low ASCVD event rates"
I recommend patients ponder all these factors and have an intense discussion with their doctor about taking a statin.
My take is, yes there must be some benefit, even if one is not just focused on MI. So it’s worthwhile starting or continuing if well tolerated and patient is willing.
Andrew,
This is definitely a topic worthy of discussion but I would point out that Rita Redberg has been opposed to any use of statins in primary prevention and therefore quite an outlier.
In my practice, I do a fair amount of deprescribing statins in the elderly. I have a very low threshold for initiating a trial of temporary statin cessation if there is any question that a patient’s symptoms could be statin-related.
The older the patient, the higher the bar for initiating statins and I think in all patients a search for subclinical atherosclerosis (coronary calcium scan or vascular ultrasound) helps inform the decision.
From a 2018 JACC article (http://www.onlinejacc.org/content/71/1/85.full)
"A promising approach to personalize treatment in elderly people is “derisking” by use of negative risk markers (i.e., absence of coronary artery calcification) to identify those at so low risk that statin therapy may safely be withheld . In the BioImage study of elderly individuals, for example, absence of coronary artery calcification was prevalent (≈1 of 3) and associated with exceptionally low ASCVD event rates"
I recommend patients ponder all these factors and have an intense discussion with their doctor about taking a statin.
https://theskepticalcardiologist.com/2018/01/17/should-you-take-a-statin-if-you-are-over-75-the-value-of-derisking-in-the-elderly/
My take is, yes there must be some benefit, even if one is not just focused on MI. So it’s worthwhile starting or continuing if well tolerated and patient is willing.