QRISK3 stops at 84. You're then in clinical judgment territory and until recently, the evidence to guide that judgment has been quite limited.
A study in the Journal of the American Geriatrics Society provides valuable insights. Lavon et al. studied more than 15,700 patients aged 80 and older. This is the largest real-world dataset for this age group to date.
These patients had no history of cardiovascular disease. They used electronic medical records and pharmacy dispensing data for their analysis. They compared people who used statins on a regular basis with those who did not. Researchers conducted this over an average follow-up period of four years. The cohort's average age was 84.5 years, and two-thirds were female.
This group is more like the patients you see in your practice than most trial populations.
Statin use lowered all-cause mortality by 31% (HR 0.69; 95% CI: 0.34–0.74). It also cut new coronary events by 20% (HR 0.80; 95% CI: 0.68–0.94). The mortality signal increased with adherence. For users with high adherence (medication possession ratio ≥80%), the adjusted mortality hazard ratio is 0.58. In contrast, it was 0.74 for lower-adherence users. A dose-response pattern like that is harder to dismiss as confounding.
Researchers found no significant differences in cases of myopathy, new diabetes, or dementia. These three issues often lead to discussions about stopping medications in older patients. Dementia findings require caution because of other health risks in this age group. Yet, the data on myopathy and diabetes are reassuring.
Two findings stand out clinically.
Patients who stopped taking statins before age 80 missed out on these benefits. Ongoing therapy led to a 25% drop in coronary events compared to those who had quit - continuation appears to matter.
Nearly 40% of the control group had used statins before. This means we can't compare them to those who have never taken statins. The true effect in patients who have never used statins might be different.
The evidence base remains contested. Earlier work from Ramos et al found no mortality or CVD benefit in over-75s without diabetes. Plus, an ASPREE analysis also showed no improvement in disability-free survival. This study doesn't resolve the contradictions. It has clear limitations. It has a retrospective design, it focuses on one geographic area and cannot confirm cardiovascular-specific mortality.
NG238 suggests using statins for those over 85. This study supports that recommendation.
These articles report on published research. It does not constitute medical advice.
