Authors: Vladimír Blaha Authors‘ workplace: III. interní gerontometabolická klinika Lékařské fakulty Univerzity Karlovy a Fakultní nemocnice Hradec Králové Published in: Geriatrie a Gerontologie 2026, 15, č. 1: 5-10 Category: Review Article doi: https://doi.org/10.61568/geri/50-6703/20260311/143071
Introduction: Atherosclerotic cardiovascular diseases represent the leading cause of morbidity and mortality in individuals aged ≥75 years. However, recommendations for lipid-lowering therapy in people older than 75 years, particularly in primary prevention, remain unclear.
Methods: This review summarizes the available evidence on the role of LDL-C as a risk marker, evaluates the efficacy of statin and non-statin therapies, and analyzes specific aspects of treatment in older adults, including deprescribing.
Results: Following an atherosclerotic cardiovascular event, lipid-lowering therapy within secondary prevention is appropriate for most older patients; deprescribing may be considered in those approaching the last months of life. Secondary prevention provides significant benefits without increasing the risk of adverse effects. In secondary prevention, the relative effect across age groups remains stable, while the absolute benefit increases with age. In primary prevention in individuals ≥75 years, observational data support statin initiation; randomized clinical trials (PREVENTABLE, STAREE) are ongoing. In individuals ≥75 years without limited life expectancy, lipid-lowering therapy may be considered within a comprehensive assessment of risks and benefits. Statins remain the cornerstone of therapy and have demonstrated reduction in cardiovascular event risk even in older adults. Ezetimibe and PCSK9 inhibitors are effective and well-tolerated alternatives. Bempedoic acid is an option for statin-intolerant patients (in the Czech Republic reimbursed as an add-on to ezetimibe), while PCSK9 inhibitors are available under strict reimbursement criteria.
Conclusion: Treatment must be individualized with regard to biological age, frailty, and prognosis. In patients with limited life expectancy, deprescribing represents an appropriate strategy. Ongoing studies may provide more precise recommendations for the population aged ≥75 years.
morbidity – statins – mortality – older adults – ezetimibe – PCSK9 inhibitors – LDL cholesterol – atherosclerotic cardiovascular diseases – lipid-lowering therapies
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