Lower Doses of Statins Might Work Better for Older Adults, Study Shows

Cyra-Lea Drummond, BSN, RN
·5 min read
20

Fact checked by Nick Blackmer

Key Takeaways

  • A recent study shows when adults begin taking statins at age 75, they may reduce their cholesterol more than younger adults who take statins.

  • Older adults may reach target cholesterol levels with a lower starting dose.

  • Statins remain among the most effective and best-studied tools for managing high cholesterol, so patients and their providers should work together to find the lowest effective dose.



A new study out of Denmark shows that individuals who begin statins after the age of 75 may see a greater reduction in their cholesterol levels than patients who start at a younger age.

Statins are a fundamental piece of heart disease prevention because they lower LDL cholesterol. This is the type of cholesterol which leads to plaque formation, causing strokes and heart attacks.

For the recent study, published in the August 2023 issue of Annals of Internal Medicine, researchers followed 83,000 patients aged 18 and older who began one of two common statins—either Zocor (simvastatin) or Lipitor (atorvastatin)—between January 2008 and March 2018. All participants had high LDL cholesterol levels (or “bad” cholesterol) before and during statin use.

Related: Should You Use Generic Cholesterol Medications?

Researchers noticed that as patients became older, their immediate response to statins increased. People aged 75 and older had a 2.62% greater reduction in LDL cholesterol with low-to-moderate intensity statins (20 milligrams) than those below age 50.



Takeaway

Of the participants, just over 10,300 (13%) were 75 or older when they began statin therapy. People below age 50 made up 20% of the study participants.



But it’s not the cholesterol reduction itself that researchers are most excited about. It’s the fact that there may be no need to increase medication dosage among older adults in order for it to be effective.

“Adverse events are generally more frequent at higher statin doses, and older persons are more susceptible to adverse events, so lower doses may be better tolerated and sufficiently effective in older patients,” Marie Lund, MD, PhD, told Verywell.

Who Was Included in the Study?

About half of the patients were using statins for primary prevention of heart disease (they had no previous heart disease, but risk factors were present), and the other half for secondary prevention (they had previous heart disease). The reduction in LDL was the same for both groups.

“We compared the LDL cholesterol response by 5-year age groups and found that the response increases linearly with age,” senior paper author Marie Lund, MD, PhD, told Verywell. “A 60-year-old initiating a low-to-moderate-intensity statin is expected to have an LDL cholesterol response that is greater than a 50-year-old, but smaller than a 70-year-old, all other things being equal.”

The study did not include individuals already on statins, did not account for BMI, and did not follow LDL cholesterol levels beyond six months of starting statins. The patient population was primarily of White European ancestry.

Related: HDL and LDL Cholesterol Range by Age

Lower Doses, Fewer Side Effects

The drop in cholesterol seen amongst older participants in the clinical trial is unlikely to lead to improved outcomes, said Adedapo Iluyomade, MD, a preventive cardiologist at Miami Cardiac & Vascular Institute, part of Baptist Health South Florida.

”A study in JAMA suggests that for every 39 mg/dL drop in LDL cholesterol, there is a 20% drop in cardiovascular disease risk, leading to fewer events such as heart attack and stroke,” Iluyomade told Verywell. “The roughly 2–3% LDL differences seen in this current study are unlikely to correlate with a significant reduction in risk for older participants versus younger participants.”

While the comparable drop in cholesterol levels may not be substantial, the reduction in side effects may be significant for the older population. Because most individuals who begin statins will need to be on them long-term, side effect concerns can be a barrier to entry when it comes to starting statins.

Related: This New Drug Lowers Cholesterol Without the Side Effects of Statins

“It’s essential to recognize that statins are generally well-tolerated. However, long-term use may be associated with rare side effects such as muscle pain and liver issues,” Iluyomade said. Multiple studies have suggested that a significant portion of muscle pain reports are due to the “nocebo effect” of fearing side effects before taking a medication, he added. “The decision to prescribe statins must always be individualized, considering the patient’s overall risk profile and potential benefits in reducing cardiovascular events.”

Since older patients may be able to achieve their target cholesterol goals with a lower dose of statins, they may be able to reduce their risk of experiencing medication side effects.

Statins remain one of the most effective and best-studied classifications of medications. An estimated 92 million U.S. adults (about one-third of the population over the age of 50) were taking statins in 2018–2019. More evidence supports statins than just about any other kind of medication. But each patient on statins and their provider should have a continuing conversation about their medication.

“Statins usually begin to lower cholesterol within a few weeks, and cholesterol levels are typically monitored every 6 to 12 months when on statins,” said Iluyomade. “The new data doesn’t change these general guidelines, but emphasizes the importance of individualized care, considering factors such as age and intensity of statin therapy.”



What This Means For You

If your cholesterol levels require the use of statins, know that your dosage may depend on your age. If you’re already taking statins, don’t change your dosage without speaking with your healthcare provider.