Intended for healthcare professionals


Primary prevention with statins for older adults

BMJ 2018; 362 doi: (Published 05 September 2018) Cite this as: BMJ 2018;362:k3695
  1. Aidan Ryan, academic clinical fellow1,
  2. Simon Heath, partner general practice2,
  3. Paul Cook, consultant in chemical pathology and metabolic medicine3
  1. 1Metabolic Medicine, Department of Laboratory Medicine, University Hospital Southampton, Southampton SO16 6YD, UK
  2. 2Hazelwood Group Practice, Warwickshire, UK
  3. 3Department of Laboratory Medicine, University Hospital Southampton, UK
  1. Correspondence to: A Ryan aidan.ryan{at}

Patient preference remains the guiding principle while we wait for better evidence

The overall prevalence, incidence, and mortality from cardiovascular disease (CVD) has decreased over the past 10 years in the developed world.1 But primary prevention remains important, particularly for adults aged more than 65 years, who experience substantial morbidity after an initial cardiovascular event—up to one third have a further event (stroke, myocardial infarction) or die within three years.2

Over the past decade, statin prescriptions for primary prevention of CVD—usually either simvastatin or atorvastatin—have increased for those aged between 60 and 80 years.3 A recent change in UK guidance means that all men aged more than 60 and women aged more than 75 are now eligible for statin treatment.4 Are statins beneficial for primary prevention of CVD in adults aged 75 or older and what are the risks?

The evidence

In a linked large retrospective cohort study of patients aged 75 or more, Ramos and colleagues (doi:10.1136/bmj.k3359) found no reduction in CVD (a composite of coronary heart disease and stroke) in those without diabetes using statin …

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