Drug Therapy of Dyslipidemia in the Elderly

  • Srikanth Yandrapalli
  • Shashvat Gupta
  • Gabriela Andries
  • Howard A. Cooper
  • Wilbert S. AronowEmail author
Review Article


Abnormal lipoprotein metabolism is an important and modifiable risk factor for atherosclerotic cardiovascular disease (ASCVD), which has been shown in numerous studies to lead to adverse cardiovascular outcomes. As cardiovascular disease (CVD) remains the major cause of morbidity and mortality globally, management of dyslipidemia is a key component of primary and secondary risk-reduction strategies. Because ASCVD risk increases with age, as the population ages, many more people—particularly the elderly—will meet guideline criteria for drug treatment. Statins (HMG-CoA reductase inhibitors) have an unequivocal benefit in reducing ASCVD risk across age groups for secondary prevention. However, the benefit of these drugs for primary prevention in those > 75 years of age remains controversial. We strongly believe that statins should be offered for primary prevention to all older individuals after a shared decision-making process that takes polypharmacy, frailty, and potential adverse effects into consideration. When considering statin therapy in the very old, competing risks of death, and therefore the likelihood that patients will live long enough to benefit from drug therapy, should inform this process. Combination therapies with ezetimibe or proprotein convertase subtilisin–kexin type 9 (PCSK9) inhibitors should be considered to facilitate the use of tolerable doses of statins. Future investigations of dyslipidemia therapies must appropriately include this at-risk population to identify optimal drugs and drug combinations that have a high benefit:risk ratio for the prevention of ASCVD in the elderly.


Compliance with Ethical Standards


No external funding was used in the preparation of this manuscript.

Conflict of interest

Srikanth Yandrapalli, Shashvat Gupta, Gabriela Andries, Howard A. Cooper, and Wilbert S. Aronow declare that they have no potential conflicts of interest that might be relevant to the contents of this review.


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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Srikanth Yandrapalli
    • 1
  • Shashvat Gupta
    • 2
  • Gabriela Andries
    • 2
  • Howard A. Cooper
    • 1
  • Wilbert S. Aronow
    • 1
    Email author
  1. 1.Cardiology DivisionWestchester Medical Center and New York Medical CollegeValhallaUSA
  2. 2.Department of MedicineWestchester Medical Center and New York Medical CollegeValhallaUSA

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