Table 1

Guideline recommendations

GuidelineWith CVDWithout CVDAdditional comments
NICE 2014 20 21 Treat in the same way as younger adults. Decisions on whether or not to start LLD therapy should be made after an informed physician–patient discussion about the risks and benefits of statin treatmentTreat in the same way as younger adults. Decisions on whether or not to start therapy should be made after an informed physician–patient discussion about the risks and benefits of LLD treatmentNo/limited evidence exists to validate CV benefits and side effects of LLDs in oldest patients. Yet, the important effect of age on CV risk suggests all older people should be offered a LLD. Take benefits from lifestyle modifications, patient preference, comorbidities, polypharmacy, frailty and life expectancy into account
ESC 201622 Treat in the same way as younger adults. However, recommendations should be followed with caution and common senseTreat in the same way as younger adults. However, recommendations should be followed with caution and common senseWe encourage a discussion with patients regarding quality of life, life potentially gained, total burden of drug treatment and uncertainties of benefit. Monitor adverse effects closely, reconsider treatment periodically
AHA/ACC 201823 70–75 years: treat in the same way as younger adults. >75 years: it is reasonable to initiate moderate/high intensity statins. Weigh potential CV risk reduction against adverse effects, drug–drug interactions, frailty and patient preferences before initiating therapy. Continue high-intensity statins if well-tolerated70–75 years: treat in the same way as younger adults. >75 years: clinical assessment, risk discussion. It may be reasonable to stop statins when functional decline, multimorbidity, frailty or reduced life-expectancy limits the potential benefits of statins
  • AHA/ACC, American Heart Association/American College of Cardiology; CV, cardiovascular; CVD, cardiovascular disease; ESC, European Society of Cardiology; LLD, lipid-lowering drug; NICE, National Institute for Health and Care Excellence.