Should Seniors Take a Statin?

Statins are among the most widely used medications for preventing heart attacks and strokes. But whether an older adult should take one is not simply a matter of looking at the LDL cholesterol number.

The decision depends on the person’s overall cardiovascular risk, including age, cholesterol levels, blood pressure, diabetes, smoking history, kidney disease, family history, and—when appropriate—coronary artery calcium (CAC).

The 2026 American College of Cardiology/American Heart Association guideline puts more emphasis on individualized risk assessment, including the PREVENT-ASCVD risk calculator, LDL-C treatment goals, lipoprotein(a), ApoB in selected situations, and CAC scoring.

What does a statin do?

Statins lower LDL cholesterol by reducing the liver’s production of cholesterol and increasing its removal from the bloodstream.

More importantly, clinical trials have shown that statins can reduce the risk of major cardiovascular events such as heart attacks and ischemic strokes in appropriately selected people.

The potential benefit is generally greater when a person’s underlying cardiovascular risk is higher.

Age makes the decision more complicated

For adults 40 to 75, there is substantial evidence supporting statin use for primary prevention in people whose cardiovascular risk is sufficiently elevated.

After age 75, the decision becomes more individualized. The 2026 ACC/AHA guideline says LDL-lowering medication can be considered after age 75 along with lifestyle measures to reduce cardiovascular risk.

The U.S. Preventive Services Task Force takes a more cautious position: for adults 76 and older who have no history of cardiovascular disease, it says there isn’t enough evidence to determine whether starting a statin provides a net benefit.

Importantly, that recommendation concerns starting a statin for primary prevention; it does not mean that someone already taking one should automatically stop.

What about coronary calcium?

This is where the conversation can change significantly.

A coronary artery calcium (CAC) scan measures calcified plaque in the coronary arteries. A higher score generally indicates a greater amount of coronary atherosclerosis and a higher future cardiovascular risk. CAC can therefore help when the decision about cholesterol-lowering treatment is uncertain.

The 2026 ACC/AHA guideline provides specific LDL-lowering recommendations based on CAC:

• CAC 1–99: A moderate-intensity statin is reasonable in appropriate patients.
• CAC 100–299: LDL-lowering therapy is recommended, with an LDL-C goal below 70 mg/dL.
• CAC 300–999: LDL-lowering therapy is recommended, with an LDL-C goal below 70 mg/dL.
• CAC ≥1,000: LDL-lowering therapy is recommended, with consideration of a statin as first-line treatment, aiming for at least a 50% reduction in LDL-C and an LDL-C below 55 mg/dL.

The guideline considers people with CAC scores of 1,000 or greater to have particularly high cardiovascular risk.

What about side effects?

Statins can cause side effects, most commonly muscle-related symptoms. Serious complications are uncommon.

For adults 40–75, the USPSTF found that the overall harms of statins are generally small and that trials did not show an increased risk of cognitive harm compared with placebo. Evidence specifically involving adults over 75 is more limited.

If someone develops possible side effects, that doesn’t necessarily mean cholesterol treatment has to end. A clinician may consider changing the dose, changing the statin, adjusting the treatment schedule, or using another LDL-lowering medication depending on the circumstances.

The better question isn’t simply “Is my cholesterol high?”

A more useful question is:

“What is my overall cardiovascular risk, and how much could lowering my LDL reduce that risk?”

Two people can have the same LDL cholesterol but very different cardiovascular risks.

That’s why factors such as CAC score, diabetes, blood pressure, smoking, kidney disease, family history, Lp(a), and ApoB can be important when deciding how aggressively to treat cholesterol. The 2026 guideline recommends measuring Lp(a) at least once in a lifetime and says ApoB can be useful in selected situations.

The bottom line

A statin isn’t automatically necessary for every older adult—and being older doesn’t automatically mean statins are unnecessary.

For someone at relatively low cardiovascular risk, the potential benefit may be modest. For someone with substantial coronary atherosclerosis or other major risk factors, the potential benefit can be considerably greater.

The goal isn’t simply to get a “good” cholesterol number. It’s to understand your overall cardiovascular risk and decide how much risk reduction is worth pursuing.

If you’re considering starting, stopping, or changing a statin, discuss your individual risk factors, current medications, cholesterol levels, and treatment goals with your healthcare professional.

Know your risk. Know your numbers. Then make an informed decision.