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Older Patients
Chart 8. Older Patients
Recommendations
Strength Quality
Primary prevention strategies in patients 65–79 years
of age should be managed in accordance with the NLA
Recommendations for the Patient-Centered Management of
Dyslipidemia-Part 1.
A High
For patients age ≥65 to <80 years of age with ASCVD or
diabetes mellitus, moderate or high intensity statin therapy
should be considered aer a careful consideration of the
risk-benefit ratio.
A High
For secondary prevention in patients ≥80 years of age,
moderate intensity statin therapy should be considered based
upon a provider-patient discussion of the risks and benefits
of such therapy, consideration of drug-drug interactions,
polypharmacy, concomitant medical conditions including
frailty, cost considerations, and patient preference.
B Moderate
Risk calculators such as the ACC/AHA Pooled Cohort Risk
calculator or the ATP III Framingham Risk Calculator can
be used in select older individuals with one additional risk
factor to further assess risk, using the thresholds for high risk
of ≥15% 10-year risk for a hard ASCVD event (MI, stroke,
or death from CHD or stroke) with the Pooled Cohort
Equations, and ≥10% 10-year risk for a hard CHD event (MI
or CHD death) using the ATP III Framingham risk calculator.
However, these risk calculators have several limitations for use
in older patients, since advanced age is oen the predominate
driver of increased ASCVD risk, and this may result in
overtreatment of lower risk older individuals.
E Low
Older, primary prevention patients who are statin-eligible
should undergo a patient-centered discussion with their
provider about the risks and benefits of statin therapy so that
they can make a more informed decision about taking statins
over the long term.
E Low
If the older primary prevention patient is unable to achieve
atherogenic cholesterol goals aer a minimum 3–6 month
trial on lifestyle modification, the provider should discuss
the pros and cons of drug therapy and, if feasible, prescribe
moderate intensity statin therapy, particularly for patients
with one or more ASCVD risk factor aside from age, with
risk exceeding the high risk threshold using the Pooled Risk
Equation or ATP III Framingham Risk Calculator.
E Moderate
CAC scoring may be useful to further assess risk in older
patients for whom questions remain about whether to
prescribe drug therapy.
E Low
