Senior Focus: Should older adults take statins?

I heard an interesting discussion at the recent American College of Cardiology meeting, led by Dr. Michael Rich, a professor of cardiology and colleague at Washington University in St. Louis. He raised the question of whether heart patients who are very old need to take statins.

The conclusion was that in the majority of cases the answer was no, though statins might be appropriate in some cases.

Statins have a number of side effects that reduce their benefit in older adults. They can damage muscles, which can lead to aches and increase the likelihood of falls.

A recent study implicated statins in causing older adults to become fatigued, which is a major cause of frailty. It also showed that in some people, statins caused functional decline.

The Food and Drug Administration has issued a “black box” warning that statins may worsen memory problems in older people. There are even cases showing that stopping statins may seem to “cure” dementia.

On the flip side, some data — not overwhelmingly strong, in my opinion — indicates that middle-aged people may be protected from developing vascular dementia if they take a statin.

So, should you take a statin if you are elderly? If you are in your mid-70s and on a statin, have your physician measure your small, dense and large, fluffy LDL cholesterol. If you have mainly large, fluffy LDL, you probably don’t need a statin.

Also, if you feel your memory is slipping, work with your doctor to make sure the statin isn’t to blame. Have your physician check your memory using a test like the St. Louis University Mental Status Examination. You can then stop your statin and have your doctor re-measure it in a few months. If your score is better, you should not go back on a statin.

For some elderly patients, the benefits of taking a statin outweigh the disadvantages. For instance, patients who have had a number of heart attacks or a recent heart attack probably need to take a statin. However, I’ve found little evidence that an expensive statin is more effective than a cheap, $4 a month statin.

The bottom line is that while there are exceptions, most people who get to old age would never have gotten there if they needed a statin. So talk to your doctor.

SLUCare physician John Morley is director of geriatrics at St. Louis University and a geriatrician at St. Louis University and Des Peres hospitals. Email him at morley@slu.edu.

http://www.stltoday.com/lifestyles/health-med-fit/senior-focus-should-older-adults-take-statins/article_cc8ebc7b-e6bd-52fe-a6dc-e7f475e9d6a2.html

Graham