When she was 74, Barbara Rivers, a former schoolteacher and administrator in Charlotte, North Carolina, was prescribed a statin — one in the popular class of drugs that lower cholesterol. This was after tests had shown that her LDL (bad) cholesterol was creeping up above the normal range.
Now 89, Rivers has been on the drug ever since. “It seems to be doing its job, and it hasn't created any side effects,” she says. “My doctor says my cholesterol is amazingly low."
Rivers is one of millions of Americans who take these lipid-lowering medications, which work by slowing down the liver's production of cholesterol overall while increasing its ability to remove LDL cholesterol in particular from the blood. By doing this, they also appear to help prevent heart attacks and strokes by keeping plaques from breaking apart and forming clots that can move to the heart or brain.
While all those benefits sound good, doctors may hesitate to prescribe this type of drug for people over 75 in the absence of clear-cut guidelines from the American College of Cardiology and the American Heart Association. Those state that you should take a statin if:
- You've had a heart attack or stroke or you have peripheral artery disease.
- Your LDL cholesterol level is 190 mg/dL or higher.
- You are 40 to 75 years old with diabetes.
- You are 40 to 75 years old with a high risk of developing heart disease or stroke and have an LDL cholesterol level of 70 mg/dL or higher.
According to the guidelines, after age 75 you should have a workup with your doctor and a discussion of risks and benefits. That's due to a lack of studies assessing the safety and effectiveness of statins for people in this age group.
"There are no clear guidelines after 75,” says cardiologist Dara Lee Lewis, M.D., an associate physician and instructor in medicine at Brigham and Women's Hospital in Boston. “And it has been difficult as a provider, because this is who our patients are.” In fact, the older you are, the greater your risk for a variety of heart ills. “About 1 in 3 Americans will ultimately die from cardiovascular disease,” Lewis says. “So everyone over 75 is at high risk.”
On the other hand, older patients are more likely to be on multiple medications that can interact with statins. And there's some evidence that this age group may be more prone to statin side effects, such as muscle pain, an increased risk of diabetes, and liver problems.