Atherosclerotic cardiovascular diseases (ASCVD) are the leading cause of death worldwide. High levels of total cholesterol—and of low-density lipoprotein cholesterol in particular—are one of the main risk factors associated with ASCVD. Statins are first-line treatment for hypercholesterolemia and have been proven to reduce major vascular events in adults with and without underlying ASCVD. Findings in the literature show that statins reduce coronary and cerebrovascular morbidity and mortality in middle-aged people, but their benefits in older adults are not as well-established, especially in primary prevention. Furthermore, many particularities must be considered regarding their use in old subjects, such as age-related changes in pharmacokinetics and pharmacodynamics, comorbidities, polypharmacy, and frailty, which decrease the safety and efficacy of statins in this population. Myopathy and a possible higher risk of falling along with cognitive decline are classic concerns for physicians when considering statin use in the very old. Additionally, some studies suggest that the relative risk for coronary events and cardiovascular mortality associated with high levels of cholesterol decreases after age 70, making the role of statins unclear. On the other hand, ASCVD are one of the most important causes of disability in old subjects, so cardiovascular prevention is of particular interest in this population in order to preserve functional status. This review aims to gather the current available evidence on the efficacy and safety of statin use in very old patients in both primary and secondary prevention.

动脉粥样硬化性心血管疾病 (ASCVD) 是全球主要的死亡原因。高水平的总胆固醇——尤其是低密度脂蛋白胆固醇——是与 ASCVD 相关的主要危险因素之一。他汀类药物是高胆固醇血症的一线治疗药物，已被证明可以减少患有或不患有潜在 ASCVD 的成人的主要血管事件。文献中的研究结果表明，他汀类药物可降低中年人的冠状动脉和脑血管发病率和死亡率，但其对老年人的益处并不十分明确，尤其是在一级预防中。此外，在老年受试者中使用时必须考虑许多特殊性，例如与年龄相关的药代动力学和药效学变化、合并症、多药性和虚弱，这会降低他汀类药物在该人群中的安全性和有效性。肌病和可能更高的跌倒风险以及认知能力下降是医生在考虑在老年人中使用他汀类药物时的典型担忧。此外，一些研究表明，与高胆固醇水平相关的冠状动脉事件和心血管死亡率的相对风险在 70 岁后降低，这使得他汀类药物的作用尚不清楚。另一方面，ASCVD 是老年受试者残疾的最重要原因之一，因此为了保持功能状态，该人群特别关注心血管预防。本综述旨在收集有关他汀类药物在老年患者一级和二级预防中使用的有效性和安全性的现有证据。肌病和可能更高的跌倒风险以及认知能力下降是医生在考虑在老年人中使用他汀类药物时的典型担忧。此外，一些研究表明，与高胆固醇水平相关的冠状动脉事件和心血管死亡率的相对风险在 70 岁后降低，这使得他汀类药物的作用尚不清楚。另一方面，ASCVD 是老年受试者残疾的最重要原因之一，因此为了保持功能状态，该人群特别关注心血管预防。本综述旨在收集有关他汀类药物在老年患者一级和二级预防中使用的有效性和安全性的现有证据。肌病和可能更高的跌倒风险以及认知能力下降是医生在考虑在老年人中使用他汀类药物时的典型担忧。此外，一些研究表明，与高胆固醇水平相关的冠状动脉事件和心血管死亡率的相对风险在 70 岁后降低，这使得他汀类药物的作用尚不清楚。另一方面，ASCVD 是老年受试者残疾的最重要原因之一，因此为了保持功能状态，该人群特别关注心血管预防。本综述旨在收集有关他汀类药物在老年患者一级和二级预防中使用的有效性和安全性的现有证据。