Best statin for older adults

In this article:

• Older adults and statins
• Statin recommendations
• Statin research
• Bottom line

In this article

• Older adults and statins
• Statin recommendations
• Statin research
• Bottom line

Statins are used to lower cholesterol levels in the blood. They block the enzyme HMG CoA reductase that makes cholesterol in the liver. For all at-risk patients and especially for older adults, statins are a key component in preventing cardiovascular disease. But with age, our bodies may process medications differently. Age-related changes in health affect how effectively the medication is metabolized, how well a drug works, and how likely it is to cause side effects. For this reason, healthcare providers often individualize statin therapy for older adult patients according to their health status and medical history.

In this article, we’ll discuss which statins are commonly prescribed to older adults, what the research says about their effectiveness and safety in this age group, and what side effects to look out for. Understanding how these medications work in older adulthood can help you make more informed decisions with your healthcare provider.

Why older adults may need a different approach to statins

Statins help prevent atherosclerosis and heart disease. Kristen Fuller, MD, a family medicine physician in Mammoth Lakes, California, explains that lowering cholesterol helps “reduce the risk of plaque buildup in blood vessels, which can reduce high blood pressure, heart attacks, and strokes.”

According to the National Institutes of Health, older adults can be people aged 65 and older, but there’s no specific age that defines older adults. While statins are widely prescribed for middle-aged adults, their use in people over 75 is less straightforward. The American Heart Association (AHA) recommends statin therapy in people ages 40 to 75 with low-density lipoprotein (LDL) cholesterol levels higher than 190 mg/dL to prevent heart attacks and strokes. For people older than 75, the U.S. Preventive Services Task Force (USPSTF) has stated there isn’t enough evidence to weigh the risks and benefits of starting statins in people older than 75 who have no history of heart attack or stroke.

That doesn’t mean statins aren’t helpful for older adults, but it does mean they require a more nuanced approach. As people age, several factors can influence how statins work in the body:

• Other health conditions: Being over the age of 60 is a risk factor for kidney disease, and older age is a risk factor for liver diseases like non-alcoholic fatty liver disease (NAFLD) and drug-induced liver injury. Statins carry a risk of impacting kidney and liver disease, which can affect how the body processes medication and increase the risk of drug interactions.
• Increased sensitivity to side effects: Statins are known to cause muscle-related side effects like pain, weakness, and myopathy. These issues may affect older adults, who already face risks of age-related muscle loss (sarcopenia) and a higher risk of falls.
• Cognitive and metabolic concerns: Warnings on statin labels state that these medications may be linked to confusion or memory issues. Statins can also slightly raise blood sugar levels, which may be a concern for those with prediabetes or diabetes.

Because of these risks, healthcare providers weigh the benefits of lowering cholesterol against a patient’s overall health status. When discussing statin treatment with your healthcare provider, it’s important to share any existing medical conditions and medications you’re taking. This helps your provider make a personalized decision and continue evaluating whether the benefits of statin therapy outweigh the risks over time.

Top recommended statins for older adults

In general, statins reduce the risk of heart attack and stroke by 20%–30% in people ages 40 to 75.  Because cardiovascular disease is a common cause of disability and death, this statistic is important.  Current research doesn’t point to any one statin as being safer or effective for older adults. Ultimately, healthcare providers will tailor treatment on an individual basis. “There is no single best statin for elderly, and statin choice will typically come down to provider preference and individual tolerance,” says Austin Shuxiao, MD, internal medicine physician, founder, and medical director of PeachIV. 

Despite the limited research comparing statins in older adults specifically, past clinical trials and studies in statin users highlight some points to consider. 

Lipitor (atorvastatin)

There isn’t much research comparing the effects of atorvastatin on older adults specifically, but there is some evidence for its benefits in this age group. In the Study Assessing Goals in the Elderly (SAGE) trial  people ages 65 to 85 taking a high dose (80 mg) of atorvastatin had a lower rate of death by any cause compared to people taking 40 mg pravastatin, but there wasn’t a significant decrease in their major cardiovascular events. 

In another study on people who had a stroke previously, 80 mg of atorvastatin decreased the risk of recurrent stroke, but increased the risk of a specific type of stroke, hemorrhagic stroke.

According to its drug label, there’s no overall difference in the safety or effectiveness of atorvastatin in older adults compared to younger adults. However, atorvastatin in older adults over 65 increases the risk of myopathy and rhabdomyolysis (muscle breakdown).

Crestor (rosuvastatin)

In clinical trials, Crestor and its generic rosuvastatin have some evidence supporting their heart health benefits in people older than 70. In the Justification for the Use of Statin in Prevention: An Intervention Trial Evaluating Rosuvastatin (JUPITER) and Heart Outcomes Prevention Evaluation-3 (HOPE-3) trials, rosuvastatin was found to lower the risk of non-fatal heart attacks and strokes and death due to cardiovascular issues by 25% in people older than 70 without a history of previous heart attack or stroke. 

According to its drug label, there’s no overall difference in the safety or effectiveness of atorvastatin in older adults compared to younger adults. However, similar to atorvastatin, adults over 65 on rosuvastatin have an increased risk of myopathy and rhabdomyolysis. 

Pravachol (pravastatin)

Pravastatin (generic Pravachol) was used in the Prospective Study of Pravastatin in Elderly at Risk (PROSPER) trial, which found some benefits of pravastatin therapy in older adults up to 82 years old. The PROSPER trial found that 40 mg of pravastatin reduced the risk of nonfatal heart attack, cardiovascular death, and stroke by 15% compared to placebo. 

In the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) trial, people older than 65 didn’t have a significant improvement in their coronary artery disease (CAD) or rate of death compared to usual care. This trial also found a higher risk of death in people over 75 using statins, but other studies done since then show no change in the risk of death in this population. 

Pravastatin’s drug label states no significant differences in safety or effectiveness between older adults and younger adults. But similar to other statins, adults 65 and older have an increased risk of myopathy and rhabdomyolysis. 

Zocor (simvastatin)

Zocor and its generic simvastatin have more of a beneficial effect in people younger than 65. In the Heart Protection Study (HPS), simvastatin decreased the risk of cardiovascular events by 24% in people younger than 65. In people 70 to 80, simvastatin still decreased the risk of cardiovascular events, 18% compared to placebo. 

People older than 65 taking simvastatin had a higher chance of myopathy and rhabdomyolysis compared to people younger than 65. 

Statin research in older adults

It’s worth noting that many of these statin trials were published more than 20 years ago. Though current research doesn’t have a clear picture of the best statins for older adults, there is a major clinical trial called Statins in Reducing Events in the Elderly (STAREE) being conducted in Australia in people 70 and older. In November 2025, STAREE researchers published a paper stating that the research project will be one of the largest clinical trials to learn more about heart disease prevention, disability-free survival, and cognition in older adults taking statins. 

Statins comparison chart
Name	Summary of research	Average cost without insurance*	Savings
Lipitor (atorvastatin)	Lower rate of death by any cause in people 65 to 85 taking 80 mg atorvastatin compared to 40 mg pravastatin Lower risk of recurrent stroke	$683 for 30, 40 mg tablets of brand-name Lipitor; or $124 for 30, 40 mg tablets of generic atorvastatin	Get coupon
Crestor (rosuvastatin)	Lower risk of non-fatal heart attacks, strokes, and death due to cardiovascular issues in people older than 70 with no previous cardiovascular events	$359 for 30, 10 mg tablets of brand-name Crestor; or $7.71 for 30, 10 mg tablets of generic rosuvastatin	Get coupon
Pravachol (pravastatin)	Lower risk of non-fatal heart attack, cardiovascular death, and stroke  Mixed results on whether pravastatin affects rate of death	$344 for 90, 40 mg tablets of generic pravastatin sodium	Get coupon
Zocor (simvastatin)	Decreases the risk of cardiovascular events in people up to 80 years old	$339 for one bottle of 30 tablets of brand-name Zocor; or $233 for 90, 20 mg tablets of generic simvastatin	Get coupon

*Average cost at time of publication. Drug prices fluctuate and may vary by pharmacy and location. 

Side effects of statins in older adults

Statins generally share a similar list of common and concerning side effects, but certain issues may be more pronounced in older adults. “The elderly are typically more sensitive to the side effects of statins, so their dosage and choice of statin should be personalized,” Dr. Shuxiao says. 

Healthcare providers may keep a few things in mind to weigh the risks and benefits of the treatment in older adult patients: 

• Muscle-related side effects such as muscle pain, weakness, and rhabdomyolysis are among the most well-known adverse reactions with the use of statins. Older adults may be at higher risk for these effects, but pravastatin and Lescol (fluvastatin) are associated with fewer muscle-related side effects compared to other statins. Pravastatin and fluvastatin are also less potent statins and decrease LDL levels less than atorvastatin and rosuvastatin. 
• Blood sugar changes can occur, particularly with higher statin doses. These may include increases in hemoglobin A1c (HbA1c) and fasting blood glucose levels. This may be a concern for those with diabetes or prediabetes.
• Liver-related side effects may appear as elevated liver enzymes in blood work. If this occurs, providers may lower the dose, switch to pravastatin, or consider alternative treatments.
• Kidney-related issues may present as protein or blood in the urine, and there’s an increased risk of kidney injury or even renal failure if rhabdomyolysis develops. Rosuvastatin and simvastatin are more likely to affect kidney function, while atorvastatin, fluvastatin, and pravastatin tend to have a lower risk.

Statins also carry the warning that they can affect cognitive function, such as memory loss and confusion. Why this happens is still not well-understood, but statin drug labels do state that this effect is reversed after stopping statin therapy. 

Bottom line 

There’s no single best statin for older adults, but some choices may be better than others depending on your overall health. Because statins have different side effect profiles and limited research in adults over 75, healthcare providers make treatment decisions on an individualized basis. Until more large-scale studies are available, it’s important to keep your healthcare provider up to date with your medical history so they can better tailor your statin therapy for the best outcome.