(Open access funding provided by Semmelweis University)
Statins are crucial in lipid-lowering therapy for reducing atherosclerotic cardiovascular
disease (ASCVD) risk. However, rhabdomyolysis, a rare but severe side effect, disproportionately
affects frail, older adults with polypharmacy and multiple comorbidities. Current
guidelines for adjusting statin dosages in older adults lack clarity. To evaluate
statin use in the geriatric population, assess benefit-risk ratios, and analyze dosage
regimens through a systematic literature review. A comprehensive search was conducted
in PubMed, Scopus, Web of Science, and EBSCO databases. Eleven original studies involving
566,509 patients were included. The review was registered on PROSPERO (CRD42024587259).
Statin therapy was associated with a lower risk of cardiovascular disease compared
to placebo. When adjusted during treatment, higher-intensity statins appeared to provide
greater benefits than fixed low-dose statins, while the likelihood of side effects
remained similar. Using ezetimibe and statins further improved outcomes and was linked
to fewer side effects. Adherence-improving techniques were crucial, especially in
older adults. Individualized statin dosing, considering titration, combination therapy,
and adherence strategies, is essential for maximizing benefits and minimizing risks
in older adults. While statins effectively reduce CVD risk, careful consideration
of patient-specific factors is necessary when prescribing to older adults.
