Atorvastatin for 73 year old. Been on statins for 30 years.

The short version: at 73, the case for staying on atorvastatin depends almost entirely on whether this person already has heart disease. If they do, the evidence is real. If they don't, it is much thinner than the schedule implies.

The retrieved records do not tell us why this person started 30 years ago, or whether they have established heart disease. That distinction is the whole question. In people over 70 who already have heart disease, statin use tracked with lower death rates over about four years [1], and in people over 70 after a heart attack, hitting a low LDL target cut new events by about 8 in 100 [1]. In primary prevention, the benefit shrinks with age: rosuvastatin cut major events by about half in people 65 to 70, but by about a quarter in those over 70 [1]. In the oldest primary-prevention group studied, the mortality reduction was not statistically significant [1].

Muscle symptoms are the real cost, and they rise with age and with how long you have taken the drug [2]. In one comparative study, 21 in 100 statin users reported muscle symptoms versus about 6 in 100 controls, and older age and longer use were independent risk factors [2]. A separate review put serious muscle breakdown at roughly 1 in 10,000 and serious liver damage at roughly 1 in 100,000 [1]. Those are the reviewer's figures, not trial data.

What this retrieval cannot see: no trial here compares 30-year users to people who stopped, and no record addresses whether the original indication still applies at 73. That is the study that would settle it, and it is not in front of me.

My call: if there is documented heart disease or prior stroke, staying on it is defensible; if this was primary prevention started decades ago, the benefit at 73 is modest and the muscle risk is real, so a conversation about dose or stopping is reasonable. Confidence: moderate.