When to Start or Stop Statins in Older Adults: Tim Anderson, Rita Redberg, Mike Rich

In 1987, lovastatin became the first FDA-approved statin in the United States. Four decades later, statins are among the most frequently prescribed medications nationwide, with atorvastatin topping the overall list. Now, updated guidelines have expanded statin eligibility to cover nearly every older adult.

On today's episode, we are joined by experts Tim Anderson, Rita Redberg, and Mike Rich to discuss when to start, and when to stop, statin therapy in older adults.

Topics we talk about on starting and stopping statins in older adults include:

• Updates and changes for statin use in older adults in the new 2026 Guideline on the Management of Dyslipidemia including:

  • The transition to the new PREVENT (Predicting Risk of Cardiovascular Disease EVENTs) equations.

  • Raising the target age for 10-year ASCVD risk estimation from 75 to 79.

  • Lowering ASCVD risk threshold categories: Low (<3.0%), Borderline (3.0% to <5.0%), Intermediate (5.0% to <10.0%), and High (10.0%).

• Clinical Implications of these new guidlines: 

  • A new study led by Tim Anderson reveals that over 93% of adults aged 70–79 now meet the criteria for primary prevention statins.

• Does the STAREE trial change anything? 

  • The STAREE trial showed a 30% reduction in major cardiovascular events with atorvastatin in older adults, yet found no significant improvement in disability-free survival or all-cause mortality. 

• Statin Discontinuation Trials: Should we change our practice now that the SAGA/SITE trial showed stopping statins in older adults who have been on them for more than a year had no impact on mortality, quality of life, cognitive function, functional status, symptom burden, and adverse events.

• Lastly, while we didnt talk about it, this is another great RCT on statin discontinuation in individuals nearing the end of life, finding no significant difference in 60-day mortality or 1-year cardiovascular event risk between statin discontinuation and continuation.