Statins at age 80?

The controversy is flaring up again—there isn’t a single consultation where patients don’t express their fears about statins and their reluctance to take them for fear of side effects, even though some… have never even taken them!

And there’s a certain complacency in this attitude, where we end up talking more about the risks than the benefits.

While the issue is clear-cut in secondary prevention: if a cardiovascular event has occurred, treatment is necessary regardless of age!

In primary prevention, things are much less clear, and some people delay starting treatment while questioning its value since they feel fine.

The problem is even more complex with older patients because, indeed, for them (yes, this is more common in women…), side effects do exist

What does the science say?

Is it harmful? Or are people too old to benefit from it?

The answer is no.

There is evidence from studies—though few compared to the total number—and observational registries showing that statins reduce cardiovascular risk regardless of age.

It’s “mathematical”—a well-known model indicates that every 0.4 g/L decrease in LDL cholesterol leads to a 23% reduction in cardiovascular events.

It is much better to start treatment early, but it is never too late, since starting a statin at age 60 will reduce cardiovascular events by 27%.

After age 65, treatment is associated with a 39% reduction in all-cause mortality and a 25% reduction in those over 75.

Finally, for those over 85—where one might have serious doubts—there is still a benefit without a marked increase in side effects in these frail patients.

Being “too old” to take a statin has become the “wrong” question to ask.

In 2026, the European guidelines on the management of dyslipidemia mark a paradigm shift in the care of older patients.

What is proposed:

The 2026 guidelines from the American cardiovascular societies (ACC/AHA) on the management of hypercholesterolemia, summarized in a review article, represent a significant advance.

For older adults, the most significant change lies in the extension of primary prevention recommendations up to age 79, thereby exceeding the long-standing upper limit of 75 years.

This represents a major shift in practice, as nearly all adults aged 76 to 79 meet the criteria for treatment based solely on their chronological age. At age 75, the average remaining life expectancy is 12 years, which provides a considerable period of time for implementing preventive interventions. The evidence regarding primary prevention in older adults now extends to lipid-lowering treatments other than statins for those over 75 without cardiovascular disease.

In secondary prevention, treatment is indicated at any age
—age should no longer be a limiting factor. The same efficacy and safety are observed, often with an even greater benefit than in younger individuals.

And for those who are intolerant, there are alternatives (including the very recent launch in France of bempedoic acid).

For primary prevention up to age 79, the use of a moderate-intensity statin is a decision made on an individual basis depending on:

- the level of cardiovascular risk, taking other risk factors into account

- other medical conditions

- life expectancy

- the patient’s priorities, as the patient still has a say in the matter once informed ""What matters most to you?"

Another key point: It is also important to know when to discontinue treatment (deprescribing).

Yes, but with caution. This should be discussed in cases of very limited life expectancy or a change in care goals. Not as an automatic response based on age.

And this must be a decision made jointly with one’s doctor, not with a neighbor or under the influence of any of the “anti-statin” advertisements that are rampant on social media, designed to sell products that are not only useless but also dangerous, since people will end up not taking proper treatment.

In conclusion

Ageism can be defined as “not prescribing treatment solely on the grounds that the person is too old.”

Do not withhold treatment simply because the patient is elderly and their risk is necessarily high; but not stopping treatment solely because the patient is elderly.

If a patient needs treatment, depending on the circumstances, they should receive it—with the necessary precautions—whether they are 40 or 80 years old!

Ultimately, alongside science, there is the human element, and it would be a shame to wrongly deprive ourselves of these treatments that have been described as “life-prolonging.”

Reference:

Nanna M.G. et al. Dyslipidemia in Older Adults: Balancing Prevention and Individual Care. J Am Coll Cardiol. 2026;87(19):2587-2890.