Recommendations for Older Adults Referenced studies that support recommendations are summarized in Online Data Supplements 18 and 19. COR LOE Recommendations IIb B-R In adults 75 years of age or older with an LDL-C level of 70 to 189 mg/dL (1.7 to 4.8 mmol/L), initiating a moderate-intensity statin may be reasonableS4.4.4.1-1 S4.4.4.1-8 IIb B-R In adults 75 years of age or older, it may be reasonable to stop statin therapy when functional decline (physical or cognitive), multimorbidity, frailty, or reduced life- expectancy limits the potential benefits of IIb B-R In adults 76 to 80 years of age with an LDL-C level of 70 to 189 mg/dL (1.7 to 4.8 mmol/L), it may be reasonable to measure CAC to reclassify those with a CAC score of zero to avoid statin therapy.S4.4.4.1-10,S4.4.4.1-11 Synopsis Mounting risk factors and subclinical disease are en- demic in the rapidly growing population of older adults. Data from RCTS4.4.4.1-1 S4.4.4.1-4 and a related meta-analy- support primary prevention with statin thera- py in older adults up to age 79 years, but some studies Nonetheless, data in older subsets ( 80 years of age) remain sparse.S4.4.4.1-6 S4.4.4.1-8 Furthermore, as adults grow older they are more susceptible to statin- including those that arise from altered pharmacokinetics and pharmacodynam- ics, as well as the impact of side effects on health is- sues such as multimorbidity, polypharmacy, frailty, and cognitive decline. In some patients, the aggregate risks associated with statins may exceed their likely benefits. 