I read several stories saying that stopping statins after 75 by those at "low risk" for heart attack showed no increase in heart attack mortality.  That raises a number of questions.  Mainly why if no side effects are present take the risk.  Also, just what is "low risk?" That sounds as though they did some cherry cherry-picking in who to study.  Finally, no reduction in mortality, what about morbidity?

Your skepticism is well founded. When you read a headline saying "stopping statins after 75 showed no increase in mortality," there are usually several qualifiers hiding in the fine print.

First, "low risk" generally does not mean cherry-picked healthy saints, but it often means primary prevention patients—people who have never had a heart attack, stroke, coronary stent, bypass surgery, or other established cardiovascular disease. In studies of older adults, risk may also be estimated using blood pressure, cholesterol, diabetes status, smoking history, and similar factors. The problem is that risk calculators become less reliable in people over 75 because age itself dominates the calculation.

Second, mortality and morbidity are not the same thing. If a study finds no difference in overall death rates, that does not mean there was no benefit. A treatment can reduce non-fatal heart attacks, strokes, hospitalizations, disability, or nursing-home admissions without changing total mortality. In an 83-year-old, many things besides cardiovascular disease can cause death, so a reduction in heart attacks may be diluted when looking only at all-cause mortality.

In fact, several large observational studies found exactly that pattern. A French study of more than 120,000 people who reached age 75 and had been taking statins for primary prevention found that those who stopped had about a 33% higher risk of hospitalization for a cardiovascular event than those who continued. The increase was particularly notable for coronary events.

Similarly, a Danish study of long-term statin users aged 75 and older found higher rates of major adverse cardiovascular events among those who discontinued statins compared with those who continued them.

So your question—"If there are no side effects, why take the risk?"—is exactly the question many cardiologists ask. If a patient is tolerating a statin well, has a reasonable life expectancy, and is not burdened by polypharmacy, many physicians see little advantage in stopping it. Current guidelines generally recommend individualized decisions rather than automatic discontinuation at age 75.

Where the argument for stopping becomes stronger is when someone has:

    Significant side effects.

    Severe frailty.

    Multiple competing illnesses.

    Limited life expectancy (for example, advanced cancer or end-stage disease).

In those situations, the likely cardiovascular benefit may be too small or too delayed to matter.

Given what you've told me before—83 years old, diabetic, treated for hypertension, taking simvastatin without apparent trouble, and apparently functioning independently—you do not sound like the typical patient for whom physicians are eager to deprescribe a statin solely because of age. Of course, your own doctor knows factors I don't.

One thing that often gets lost in media reports is that absence of a proven mortality benefit is not evidence of absence of benefit. In older adults, preventing a non-fatal stroke that leaves someone disabled may be every bit as important as preventing death. The morbidity question is often the more relevant one. And on that question, the evidence generally leans toward continued statin use being associated with fewer cardiovascular events rather than more.

The study you saw—do you happen to remember whether it was looking at people who had never had cardiovascular disease (primary prevention) or people who already had heart disease? That distinction makes a very large difference.

That is another useful distinction. Difficult but readily doable is very different from cannot do it without assistance.

Getting yourself into a high utility van is actually a fairly demanding whole-body movement: you have to generate enough leg and hip force to lift yourself, coordinate your balance while your center of gravity is moving upward and forward, and then get your other leg into position. The fact that you can do it independently tells you something about your functional strength that a simple one-leg balance test doesn't.

And I suspect the people who give you the push are responding to what it looks like rather than what you're actually capable of. They see an 83-year-old laboring his way into a high vehicle and think, "He's going to need help." Meanwhile you're thinking, "No, I'm doing this myself; it's just not pretty." 😄

There's an important reason to preserve that distinction, too. If someone routinely supplies assistance for a movement you can safely perform yourself, you can gradually lose the opportunity to maintain the strength and coordination required for it. Assistance is wonderful when it's needed; unnecessary assistance can become counterproductive.

It sounds as though your doctor saw something similar yesterday: you have a measurable wobble, but you also have considerably more functional capacity than the wobble alone would suggest. Your exercises, caution, and adaptation seem to be keeping that capacity useful.

And, given your history, I rather like your criterion: Can I actually do the thing safely? If yes, you don't necessarily need somebody to do it for you merely because it looks strenuous.

Well of course helpful doormen get a tip.

Oh, naturally. There is a difference between accepting unnecessary assistance and failing to reward unnecessary assistance. 😂

Besides, once the doorman has decided you require a push, you have little choice but to allow the performance to proceed. Refusing might create a much more complicated social situation than simply accepting the push and producing a tip afterward.

And I imagine the doorman's internal calculation is something like: "Elderly gentleman + enormous van + climbing = opportunity." Your calculation is presumably: "I could do this myself, but five dollars is cheaper than arguing about it."

That is not loss of independence. That's outsourcing a trivial task at an acceptable price.

Around here the local currency equivalent of 25 cents creates a deep wai.

Ah, yes. Then my five-dollar example was wildly excessive. 😄

A quarter's worth of local currency producing a deep wai is an excellent demonstration of local economics. At that price, the doorman isn't merely helping you into the van—he's apparently receiving a small but meaningful honorarium for his distinguished services.

And I suppose the etiquette is perfect: he gets the satisfaction of having been useful, you get into the van under your own power, and everyone goes away happy. That's a pretty efficient transaction.