Table 1.
National and international guidelines for statin use in primary prevention of cardiovascular disease in older adults.
| Guideline | Year | Risk Assessment | Age (years) | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 40 | 45 | 50 | 55 | 60 | 65 | 70 | 75 | 80 | 85 | 90 | |||
| AHA/ACCa | 2018 | PCEb | |||||||||||
| LDL-C 70-189 mg/dL and 10-year risk ≥ 7.5%c | IIbh | ||||||||||||
| ACC/AHAa | 2019 | PCEb | |||||||||||
| LDL-C 70-189 mg/dL and 10-year risk ≥ 7.5%c | |||||||||||||
| USPSTFa | 2022 | PCEb | |||||||||||
| 10-year risk ≥ 10% and risk factord | |||||||||||||
| VA/DoDa | 2020 | VARS-CVD/PCE/FRSb | |||||||||||
| 10-year risk ≥ 12% | |||||||||||||
| ESC/EASa | 2019 | SCOREb | |||||||||||
| LDL > 100 mg/dL and 10-year risk 5-9.9% | "According to level of risk" e | IIbi | |||||||||||
| LDL > 70 mg/dL and 10-year risk ≥ 10% | |||||||||||||
| CCSa | 2021 | FRS/CLEMb | |||||||||||
| 10-year risk ≥ 20% OR 10-19.9% and risk factorf | |||||||||||||
| NICE UKa | 2023 | QRISK3b | |||||||||||
| 10-year risk ≥ 10%g | |||||||||||||
| Recommendation Strength | I | IIb | Strength of Recommendation Absent | Indeterminate | No Recommendation | ||||||||
2018 AHA/ACC Guideline on the Management of Blood Cholesterol; 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease; 2022 United States Preventative Services Task Force (USPSTF) Recommendation Statement for Statin Use for the Primary Prevention of Cardiovascular Disease in Adults; 2020 VA/DoD Clinical Practice Guideline For The Management of Dyslipidemia For Cardiovascular Risk Reduction; 2019 ESC/EAS Guidelines for the Management of Dyslipidaemias: Lipid Modification to Reduce Cardiovascular Risk; 2021 Canadian Cardiovascular Society (CCS) Guidelines for the Management of Dyslipidemia for the Prevention of Cardiovascular Disease in Adults; 2023 NICE UK Guideline for Cardiovascular Disease: Risk Assessment and Reduction, Including Lipid Modification.
Pooled Cohort Equation (PCE), VA Risk Score-CVD (VARS-CVD), Framingham Risk Score (FRS), Systematic Coronary Risk Estimation (SCORE), Cardiovascular Life Expectancy Model (CLEM), QRISK3.
Adults aged 40-75 with diabetes mellitus or 20-75 with LDL-C ≥ 190 mg/dL are also recommended for therapy.
Risk factors (RF) include dyslipidemia, diabetes mellitus, hypertension, or smoking.
Recommend statin treatment for primary prevention ≤ 75 "according to level of risk," although SCORE is notably only validated until age 65.
LDL-C ≥ 3.5 mmol/L OR Non-HDL-C ≥ 4.2 mmol/L OR ApoB ≥ 1.05 g/L OR Men ≥ 50 years/Women ≥ 60 years with one RF (low HDL-C, high waist circumference, smoking, hypertension) OR one RF (high-sensitivity CRP ≥ 2.0 mg/L, CAC > 0 AU, family history of premature CAD, Lp(a) ≥ 50 mg/dL).
If 10-year risk < 10%, can consider statins in patients that have " an informed preference for taking a statin or there is concern that risk may be underestimated."
Statin therapy "may be reasonable" in adults > 75 with an LDL-C 70-189 mg/dL. "Functional decline, multimorbidity, frailty, or reduced life expectancy" may be reasons for statin discontinuation in adults > 75. In adults 76-80 with an LDL-C 70-189 mg/dL, it "may be reasonable" to measure CAC, as a CAC score of zero may avoid statin therapy.
Initiation of statin therapy for primary prevention in adults > 75 may be considered if at "high-risk."