<p>Statins are crucial in lipid-lowering therapy for reducing atherosclerotic cardiovascular disease (ASCVD) risk. However, rhabdomyolysis, a rare but severe side effect, disproportionately affects frail, older adults with polypharmacy and multiple comorbidities. Current guidelines for adjusting statin dosages in older adults lack clarity. To evaluate statin use in the geriatric population, assess benefit-risk ratios, and analyze dosage regimens through a systematic literature review. A comprehensive search was conducted in PubMed, Scopus, Web of Science, and EBSCO databases. Eleven original studies involving 566,509 patients were included. The review was registered on PROSPERO (CRD42024587259). Statin therapy was associated with a lower risk of cardiovascular disease compared to placebo. When adjusted during treatment, higher-intensity statins appeared to provide greater benefits than fixed low-dose statins, while the likelihood of side effects remained similar. Using ezetimibe and statins further improved outcomes and was linked to fewer side effects. Adherence-improving techniques were crucial, especially in older adults. Individualized statin dosing, considering titration, combination therapy, and adherence strategies, is essential for maximizing benefits and minimizing risks in older adults. While statins effectively reduce CVD risk, careful consideration of patient-specific factors is necessary when prescribing to older adults.</p> Graphical Abstract <p></p>