Is Middle Age Already Too Late to Initiate Statin Therapy?

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The MD Magazine Peer Exchange “Amassing the Clinical Evidence for Optimized Dyslipidemia Management: Vitamin D, Long-Term Statin Outcomes, and PCSK9 Inhibition” features expert insight and analysis of the latest information on managing hypertension and hyperlipidemia, and in-depth discussion on the use of PCSK9 inhibitors in practice.

This Peer Exchange is moderated by Peter Salgo, MD, professor of medicine and anesthesiology at Columbia University and an associate director of surgical intensive care at the New York-Presbyterian Hospital in New York City.

The panelists are:

• Christie Ballantyne, MD, Co-director of the Lipid Metabolism and Atherosclerosis Clinic at The Methodist Hospital, Director of the Center for Cardiovascular Disease Prevention at the Methodist DeBakey Heart Center, and the Chief of Cardiology at Baylor College of Medicine
• Keith C. Ferdinand, MD, Immediate Past Chair of the National Forum for Heart Disease and Stroke Prevention, and Professor of Clinical Medicine at the Heart and Vascular Institute at Tulane University School of Medicine
• Jennifer G. Robinson, MD, MPH, Professor in the Departments of Epidemiology & Medicine and Director of the Prevention Intervention Center, Department of Epidemiology at the College of Public Health, University of Iowa
• Karol E. Watson, MD, PhD, Professor of Medicine and Cardiology, Co-director of the UCLA Program in Preventive Cardiology, and Director of the UCLA Barbra Streisand Women’s Heart Health Program

Because the long-term preventive benefits of statin therapy were shown in middle-aged patients in the West of Scotland Coronary Prevention Study (WOSCOPS), that means “the good news is that it’s not too late once you reach middle age,” said Watson. The other side of this is that a patient’s risk factors at age 50 or 55 years predict much of their outcomes through the rest of their lifetime, said Robinson. Basically, at age 60 years, for example, more aggressive treatment will be needed, but it’s not too late to see a benefit, agreed Watson and Robinson.

Perhaps the concept of successful aging needs to be reframed, said Ballantyne. It used to mean people were free from disease. But now people live much longer and more successfully after cardiac events with the proper treatment. So successful aging may now mean living independently, walking, no dementia and no cognitive decline, which is an attainable goal with aggressive treatment and a healthy lifestyle, he said. And it is never too late to adopt a healthy lifestyle, said Robinson.