Disorders of lipid metabolism

With increases in life expectancy and growth of the elderly population, including the very old, the topic of dyslipidemia in the elderly is becoming increasingly important. The risk of cardiovascular events attributable to elevated cholesterol in the elderly population is extremely high. Despite established benefits and clinical guideline recommendations, many high-risk older individuals are not receiving statins and other evidence-based lipid-lowering therapies. Clinicians must engage patients in discussions about the benefits and risks of therapy incorporating the most recent literature, their knowledge of the patient, experience, and clinical judgment in deciding which patients to offer statins or other lipid-lowering treatments such as ezetimibe, bempedoic acid, and PCSK9 inhibitors. The decision should consider patients’ overall healthcare goals, competing risks and life expectancy, and possible side effects and quality of life. Put simply, age alone should not preclude treatment; instead, a careful benefit–risk analysis should guide therapy decisions.