Do you recommend starting a statin in patients above 75 years old with diabetes but no known ASCVD?

The time to benefit (TTB) for statins in primary prevention of cardiovascular events is generally about 1.5 to 3 years. This means that adults aged 50 to 75 years typically need to take statins for at least 2.5 years to achieve a meaningful reduction in major adverse cardiovascular events (MACE), such as myocardial infarction or stroke. For patients with limited life expectancy (less than 2.5 years), the likelihood of benefit is low, and the risks may outweigh the potential gains.

I use ePrognos...

Taking into consideration a patient’s comorbid conditions, functional status, polypharmacy, and overall quality of life, I may counsel for starting a statin in a patient in her 70s with diabetes.

This is a good place to practice using the 4Ms and "What Matters Most." The ASCVD risk evaluation generally gives us a 10-year risk prognosis, even if we can't use it past age 75. But we can use that as a framework.

If this is a patient in their late 70s with well-controlled diabetes, with limited other medical comorbidities, good functional status, and, say, an estimated 20-year life expectancy, I would discuss a statin. Some may not wish to add another medicine to their regimen and focus on no...

From the standpoint of an interventional cardiologist, I would recommend high-intensity statin therapy. In theory, the “what matters most“ sounds great; however, at crunch time, when an elderly patient is found to have complex multivessel CAD, they almost always opt for high-risk procedures. Rarely does the patient or the family say, “No, I’m good, I’ll just go home and live out my life“. So from my standpoint, if there’s any chance of preventing the patient from getting to that point, I would t...