In some patients, the aggregate risks associated with statins may exceed their likely benefits. Limited life spans may also undercut the minimum time for likely statin benefits, especially the 4 to 5 years as- sociated with statins stroke-reducing benefits.S4.4.4.1-15 Decisions to not initiate statins, or even to depre- scribe them, are reasonable in older adults when aggregate risks outweigh potential for meaningful A shared decision-making process between clinicians and patients that targets individualized decisions is warranted, with regular reas- sessments over time. CAC determinationS4.4.4.1-10,S4.4.4.1-11 focuses statin therapy on those who benefit most. For older adults with CAC scores of zero, the likelihood of benefits from statin therapy does not outweigh the risks. Recommendation-Specific Supportive Text 1. An RCT enrolling 5084 men and women 70 to 82 years of age showed no benefit from pravas- tatin 40 mg/d versus placebo in the primary- Another RCT using pravastatin 40 mg per day versus usual care in older adults showed no statin benefitS4.4.4.1-19 but there were important concerns about both adherence in those assigned to pravastatin and drop-in statin therapy in those assigned to A recent meta- combining data from JUPITER and HOPE-3 in those 70 years of age showed a statistically significant 26% RRR for nonfa- tal MI, nonfatal stroke, or cardiovascular death. A prospective cohort studyS4.4.4.1-5 comparing healthy older patients (age 70 years) who used statins with those who did not showed signifi- cantly lower risk of death but nonsignificant car- diovascular event reduction in the statin group. Other recent meta-analysesS4.4.4.1-6 S4.4.4.1-8 support primary prevention for adults in their 70s. Thus, clinician patient discussion of risk versus benefit remains particularly important with inconsistent support and few data for adults >80 years of age. 