At what age is statin no longer beneficial? Examining the evidence for older adults

October 11, 2025 •

4 min read

The average lifespan is increasing globally, and with it comes a growing older population facing cardiovascular disease risk. For this demographic, a key question for patients and clinicians is, "At what age is statin no longer beneficial?" The answer is not a simple number, but rather a nuanced assessment that depends on whether the medication is used for primary or secondary prevention and the patient's overall health.

Quick Summary

The benefit of statins in older adults depends on the prevention type. For secondary prevention in those with existing cardiovascular disease, evidence strongly supports continued use regardless of advanced age. For primary prevention, benefits become less clear and require a personalized risk-benefit discussion, particularly in individuals over 75.

Key Points

Age is Not a Fixed Cutoff: There is no specific age at which statin therapy is no longer beneficial; the decision is complex and personalized, depending on the patient's individual health history and treatment goals.
Secondary Prevention Benefit Continues: For older adults with a history of heart attack, stroke, or other ASCVD, statins provide clear and consistent benefits and should generally be continued, even at advanced ages.
Primary Prevention Needs Individual Assessment: For adults starting statins for primary prevention (without prior ASCVD), the evidence is less certain after age 75. Guidelines emphasize a shared decision-making process based on overall health, risks, and life expectancy.
Risks and Side Effects Increase with Age and Complexity: Older patients may face higher risks from drug interactions (polypharmacy), muscle side effects, and potential impact on quality of life, which must be weighed against cardiovascular benefits.
Consider Deprescribing in Specific Contexts: Deprescribing (stopping statins) may be appropriate for patients in palliative care, those with limited life expectancy (<2 years), or when side effects significantly impact quality of life, but this should always be done under medical guidance.
Stopping Abruptly Can Be Risky: Evidence suggests that abrupt cessation of statin therapy in healthier older adults can increase the risk of cardiovascular events and should be avoided.
Ongoing Research Will Provide More Clarity: Ongoing large-scale clinical trials (e.g., STAREE, PREVENTABLE) are investigating the long-term benefits and harms of primary prevention statins in very elderly populations and will help inform future guidelines.

The Nuance of Prevention: Primary vs. Secondary

Determining the appropriateness of statin therapy in older adults requires a crucial distinction between primary and secondary prevention. Secondary prevention refers to treating patients with a known history of atherosclerotic cardiovascular disease (ASCVD), such as a heart attack, stroke, or peripheral artery disease. In these cases, the evidence is robust and consistently supports continuing statin therapy to prevent future events, regardless of age. A large 2019 meta-analysis of individual patient data from 28 randomized controlled trials confirmed a sustained benefit in older patients with prior vascular disease. In fact, because older adults are at a higher baseline risk for cardiovascular events, the absolute risk reduction from statins can be even greater than in younger patients.

Primary prevention, on the other hand, involves treating individuals with risk factors but no pre-existing ASCVD to prevent a first event. For this group, the evidence becomes less clear with advancing age, particularly after 75. This is largely due to the underrepresentation of very elderly individuals in landmark statin trials, leading major health organizations like the U.S. Preventive Services Task Force (USPSTF) and the American College of Cardiology/American Heart Association (ACC/AHA) to issue equivocal or no firm recommendations for primary prevention statins in adults 76 and older.

The Shifting Evidence for Primary Prevention in the Very Elderly

While historical data for primary prevention in the very old has been limited, recent observational studies and new data are emerging. A 2024 observational study using electronic health records found that for primary prevention, statins were associated with a reduced risk of cardiovascular events and mortality, even in individuals 85 and older. This benefit was observed across age groups (60-74, 75-84, and 85+). However, a 2019 meta-analysis of older individuals (>75 years) without prior vascular disease did not find a significant benefit for primary prevention. These contrasting results highlight the need for cautious interpretation, as observational studies cannot prove causation like randomized controlled trials (RCTs).

Several large RCTs are currently underway to provide more definitive answers. The STAREE and PREVENTABLE trials are enrolling older adults (70+ and 75+, respectively) to evaluate the benefits and harms of statin therapy for primary prevention, including effects on cardiovascular events, dementia, and disability.

The Risk-Benefit Balance in Older Adults

Age-related changes and health complexities impact the risk-benefit equation for statin use. Factors that can influence this balance include:

Polypharmacy: Older adults often take multiple medications, increasing the risk of drug-drug interactions with statins.
Adverse Effects: While rare, side effects like muscle aches and weakness (myalgia), potential cognitive issues, and increased diabetes risk can occur and may have a greater impact on quality of life in the very elderly. However, some studies have shown older patients report fewer muscle symptoms than younger ones, and cognitive effects are often reversible upon discontinuation.
Frailty and Comorbidities: Frailty, functional decline, and other health conditions compete with cardiovascular prevention as therapeutic priorities. A decision to continue statins should consider a patient's overall goals and life expectancy.

Shared Decision-Making and Statin Deprescribing

Given the complexity, shared decision-making between a patient and their physician is critical for older adults. This discussion should weigh the potential benefits of continuing or initiating statins against the risks of side effects, drug interactions, and overall treatment burden.

For patients already on statins, the decision to stop, or "deprescribe," requires careful consideration. Studies have shown potential risks associated with stopping statins in older patients. For instance, a 2019 French study found that older individuals (75-79) who discontinued statins had a higher risk of hospital admission for a cardiovascular event. Another study in older, multimorbid Italian patients noted increased heart failure hospitalizations after statin discontinuation. Therefore, abrupt cessation without medical guidance is not recommended.

Deprescribing may be appropriate in specific contexts:

Limited life expectancy (e.g., less than 2 years) or end-of-life care, where the long-term preventive benefits are no longer relevant.
In palliative care, where the focus shifts from prevention to maximizing comfort and quality of life.
When serious or debilitating side effects limit quality of life.

Primary vs. Secondary Prevention in Older Adults: A Comparison Table


Feature	Secondary Prevention (Known ASCVD)	Primary Prevention (No ASCVD)
Patient Population	Individuals with a history of heart attack, stroke, or peripheral artery disease.	Individuals with cardiovascular risk factors but no prior ASCVD event.
Evidence for Benefit	Strong evidence across all adult ages, including the very elderly (>85).	Clear benefit up to age 75. Beyond age 75, evidence is less certain, with conflicting observational studies and insufficient RCT data for initiation.
Guideline Recommendations	Clear, strong recommendations to continue therapy regardless of advanced age, often at moderate- to high-intensity.	Recommendations become equivocal or state insufficient evidence for initiation in those 76+, emphasizing shared decision-making.
Absolute Benefit	High, given the increased baseline risk of a recurrent event.	Varies significantly. Potentially smaller or uncertain in the very elderly, especially those without high-risk factors like diabetes.
Decision Making	Focus is on maintaining therapy and monitoring for side effects.	Requires a comprehensive discussion weighing patient values, life expectancy, potential side effects, and competing risks.

Conclusion: No Simple Age Cutoff

Ultimately, there is no single age at which statin therapy becomes definitively non-beneficial. The decision is highly individualized and must consider a patient's overall health, life expectancy, and specific clinical context. For secondary prevention, the benefits are clear and continue late into life. For primary prevention, while evidence suggests potential benefits, especially in high-risk individuals, the case becomes less compelling and more uncertain with advanced age, necessitating a robust discussion between the patient and their clinician. As ongoing trials provide more data, our understanding will continue to evolve, further clarifying the appropriate use of statins in the oldest populations.

Visit the NIH website for more information on the PREVENTABLE and STAREE trials in older adults.

Frequently Asked Questions

There is no definitive age to stop taking statins. The decision should be based on an individual's overall health, life expectancy, and whether the statin is for primary or secondary prevention. For those with established cardiovascular disease, continuation is often recommended.

Yes, statins are generally considered safe for older adults, and adverse effects are often less frequent or manageable. However, the balance of benefits versus potential risks (like muscle pain or polypharmacy interactions) must be assessed on an individual basis with a doctor, especially for primary prevention.

For primary prevention in healthy individuals over 75, the evidence is insufficient to make a strong, universal recommendation. Current guidelines advise a personalized discussion with a healthcare provider, considering the patient's specific risk factors, life expectancy, and preferences.

For those with a history of cardiovascular events, stopping a statin can increase the risk of another event, such as a heart attack or stroke. In all cases, abrupt cessation can cause cholesterol levels to rebound, so any decision to discontinue should be made with a doctor's guidance.

Yes, for some individuals, particularly those in end-of-life care, with limited life expectancy (<2 years), or significant frailty, the burden and potential harms of statins may outweigh the long-term preventive benefits. A conversation about deprescribing can be appropriate in these situations.

While some rare reports of temporary cognitive impairment have been associated with statin use, larger analyses and meta-analyses have not confirmed a causal link. Often, these effects are reversible upon discontinuation and have not been a significant concern in clinical trials.

For older patients with known cardiovascular disease, continuing statin therapy past age 85 is often recommended based on evidence of sustained benefit. For primary prevention, the decision should be made in consultation with a doctor, weighing the potential benefits against other health considerations.