Does Everyone Over 75 Need Statins to Lower Cholesterol?

The American Heart Association and the American College of Cardiology have just issued new guidelines for preventing heart disease. Presumably, these organizations expect doctors to follow their new recommendations. It would be worthwhile to learn more about the changes they suggest. Do the guidelines still insist that everyone over 65 or so should take statins to lower cholesterol, even if they have perfect cholesterol numbers, normal blood pressure and no family history of heart disease? That appeared to be the situation under the previous guidelines.

How the New Guidelines for Heart Health Have Changed

One thing that stands out is timing. The experts suggest starting cholesterol testing much younger, possibly even in childhood (JACC Journals, March 13, 2026). Younger adults, between 20 and 30 should aim for LDL-cholesterol levels below 100. People at higher risk will be encouraged to get their LDL level below 70. According to the guidelines, the best calculator to assess risk is the American Heart Association’s PREVENT-ASCVD. This new risk calculator is supposed to evaluate a longer risk period than the previous calculator. In addition, People with heart disease and those with diabetes need more intensive treatment than those at low risk.

Cholesterol Goals

The previous guidelines had eliminated specific cholesterol goals, but in 2026 they’re back. Doctors are expected to aim for a particular percent reduction in the patient’s LDL cholesterol based on the calculated risk over 10 years. People at high risk for developing atherosclerosis will be encouraged to get their LDL-C under 70. Those who already have cardiovascular disease should go for 55 mg/dL or less. The only way to reduce LDL cholesterol that much is with drug therapy.

Looking Beyond Cholesterol to Other Risk Factors

Lipoprotein (a)

Cholesterol is not the only risk factor addressed by the new guidelines. They also recommend testing for lipoprotein (a), also known as Lp(a). This is an independent risk factor for atherosclerosis, especially at levels of 50 mg/dL or higher. For years, cardiologists have known that Lp(a) could contribute to heart disease risk, but they did not have a good way to treat it. Perhaps that is why they rarely measured it. Standard cholesterol-lowering diets don’t help lower Lp(a), and neither do statins. In fact, those cholesterol-lowering drugs may even raise Lp(a). With new pharmaceuticals to lower this compound in the pipeline, doctors may feel more comfortable evaluating it for potential treatment.

Apolipoprotein B

Apolipoprotein G (ApoB) is another risk factor that has often been overlooked in the past. The new guidelines suggest that doctors measure ApoB if LDL cholesterol goals have been met but triglycerides remain high (over 200 mg/dL). ApoB particles conduct cholesterol into the lining of arteries and are therefore intimately involved in the development of atherosclerosis (JAMA Cardiology, Dec. 1, 2019).

Coronary Artery Calcium (CAC)

The guidelines also suggest measuring coronary artery calcium in men 40 years or older and in women 45 years and above. Plaque in arteries contains calcium as well as cholesterol, but calcium shows up on imaging whereas cholesterol is hard to see. The new guidelines suggest that CAC can guide doctors in establishing LDL cholesterol and non-HDL cholesterol goals.

Other Medical Conditions

The authors of the guidelines suggest that people between 40 and 75 years with diabetes, chronic kidney disease stage 3 or 4 or HIV should get lipid-lowering drugs (usually statins) even if they don’t have heart disease. These are all conditions that can make people more susceptible to cardiovascular complications. Presumably that is also the reason for “considering” cholesterol-lowering medication plus lifestyle changes for anyone over 75. We’ll be curious to see how often statins to lower cholesterol get considered but not prescribed.

People who already have heart disease should get treatment that brings their LDL cholesterol under 55 and the non-HDL cholesterol under 85. People with high triglycerides should be treated with statins; if triglycerides are 1000 mg/dL or more, they also need drugs specifically aimed at lowering triglycerides. Such high triglycerides can increase the risk for pancreatitis.

In a preamble, the guideline authors caution that these “should not replace clinical judgment.” In the past, patients sometimes wondered if doctors were relying more on the guidelines than on the situation of the individual patient. That is what prompted this question a decade ago.

Does Everyone Over 75 Need Statins to Lower Cholesterol?

Q. I am 76. At my recent check-up, all my blood tests were within normal range, including triglycerides, HDL, LDL, total cholesterol and glucose. I take lisinopril for blood pressure and metformin for diabetes.

My doctor prescribed simvastatin “as a preventative to heart attack and/or stroke.” I’ve heard statins can have bad side effects such as liver damage or muscle pains and I do not want to take any more medication than is necessary. If all my numbers are within normal range, is it necessary to take a statin because my doctor said he “prescribes this to all his senior patients”?

A. People who have had a heart attack or a diagnosis of heart disease may need a statin, but there is a great deal of controversy over whether healthy older people such as yourself benefit from such medications.

There was a time when some cardiologists almost advocated putting statins in the water supply. That might have been a hard sell. But the idea of statin shakers, instead of salt shakers, was mentioned more than once by highly respected cardiologists. They perceived statins as super safe with virtually no side effects and they were convinced that such drugs prevented many heart attacks and saved large numbers of lives, even for people with no obvious risk factor for heart disease.

Statins to Lower Cholesterol: Previous AHA Recommendations

If you went to the American Heart Association “risk calculator” back then and put in the following numbers:

Age: 76
Female: yes
Total cholesterol: 180
HDL cholesterol: 85
Systolic blood pressure: 120
Diastolic blood pressure: 80

You would be advised:

“On the basis of your age and risk for heart disease or stroke, the ACC/AHA guidelines suggest you should be on a moderate to high intensity statin.”

That was even though all those numbers are perfect–except for the birthday count. If you checked the boxes that say “treated for high blood pressure and diabetes” the unequivocal recommendation is to take statins to lower cholesterol. What was apparently forgotten in this equation is something called the ACCORD trial.

In this large, well-controlled clinical experiment, people with type 2 diabetes were followed for about eight years to see what impact lowering systolic blood pressure to 120 and getting bad LDL cholesterol below 100 would have on important health outcomes.

The authors concluded that (JAMA, July 7, 2010):

“Tight control of systolic BP among patients with diabetes and CAD was not associated with improved cardiovascular outcomes compared with usual control.”

Another surprise: subjects with type 2 diabetes who got both blood pressure and blood cholesterol into the target range did not have better cognitive function than volunteers on placebo (JAMA Internal Medicine, online, Feb. 3, 2014).

What About Longevity when People Take Statins to Lower Cholesterol?

A review of research on statins and survival reveals that otherwise healthy people taking drugs like atorvastatin, pravastatin or simvastatin live roughly three extra days after several years of treatment (BMJ Open, Sept. 24, 2015).

The statistics on this are a bit complicated, but suffice it to say the benefits for older people may not be as great as your doctor thinks. If your blood pressure and blood sugar are well controlled, the benefits of adding statins to lower cholesterol remain confusing.

Statins and Blood Sugar:

One paradox that many health professionals have a hard time with involves the impact of statins on blood sugar. It took a long time for researchers to discover that statins increase the risk for developing type 2 diabetes. There is still controversy regarding the question of whether statins make it harder to control blood sugar in patients diagnosed with diabetes.

We have heard from visitors to this website that statins to lower cholesterol can disrupt blood sugar control.

A Finnish study (Diabetologia, May, 2015) revealed a stronger link between statins and type 2 diabetes than most cardiologists imagine. The study also confirmed what visitors to our website have been saying for a long time. Statins to lower cholesterol make it harder to control blood sugar. To us, this seems like a counterproductive exercise. It is a bit like trying to climb a very steep hill with lead overshoes on your feet.

What Else Can You Do?

Cholesterol is only one of over 240 other risk factors that contribute to heart disease. To learn more about how you can improve your odds of avoiding a heart attack, check our eGuide. Look for Cholesterol Control and Heart Health. Our podcast might also be of interest. It is Show 1450: Beyond Cholesterol–Rethinking Your Risk of Heart Disease.