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Statin Discontinuation and Cardiovascular Events Among Older People
Quick Takes
- Statin discontinuation is associated with a higher risk for CV events among older adults with a prior history of CVD.
- Stopping statin therapy is associated with a higher risk for CV events among older adults with no prior history of CVD.
Study Questions:
Is statin discontinuation associated with increased major adverse cardiovascular events (MACE) among adults ≥75 years?
Methods:
This cohort study included all adults ≥75 years, residing in Denmark, who had been treated with statins for ≥5 years as of January 2011. Participants were followed through December 31, 2016. The primary outcome of interest was rates of MACE (myocardial infarction [MI], ischemic stroke or transient ischemic attack, coronary revascularization, and death due to MI or ischemic stroke) comparing adults who continued statin therapy versus those who discontinued statins. Analyses were conducted separately for primary prevention (no history of cardiovascular disease [CVD]) and secondary prevention (history of CVD). In the primary prevention group, 3,085 discontinuers (37%) were censored for restarting statins, and in the secondary prevention group, 3,541 (36%) were censored for restarting.
Results:
A total of 67,418 adults aged ≥75 years were included in the present analysis, of which 27,463 were included in the primary prevention cohort (median age, 79 years [IQR, 77-83 years]; 18,134 [66%] female) and 38,955 were in the secondary prevention cohort (median age, 80 years [IQR, 77-84 years]; 18,717 [47%] female). The median duration of follow-up in the main analysis was 5.5 years (IQR, 2.8-5.5 years) in the primary prevention cohort and 4.2 years (IQR, 1.8-5.5 years) in the secondary prevention cohort. The discontinuation rate over the follow-up period was 30% (89,311 of 27,463 persons) in the primary prevention cohort and 25% (9,853 of 39,955 persons) in the secondary prevention cohort. In the primary prevention cohort, the weighted rate difference was 9 per 1,000 person-years (95% confidence interval [CI], 5-12 per 1,000 person-years) and the adjusted sub–hazard ratio was 1.32 (95% CI, 1.18-1.48), corresponding to one excess MACE per 112 persons who discontinued statins per year. In the secondary prevention cohort, the weighted rate difference was 13 per 1,000 person-years (95% CI, 8-17 per 1,000 person-years) and the adjusted sub–hazard ratio was 1.28 (95% CI, 1.18-1.39), corresponding to one excess MACE per 77 persons who discontinued statins per year.
Conclusions:
The investigators concluded that in this cohort study, among older adults receiving long-term statin treatment, discontinuation of statins was associated with a higher rate of MACE compared with statin continuation in both the primary and secondary prevention cohorts.
Perspective:
As the authors point out, this study was not a randomized controlled trial. However, these data do suggest that continuing statin therapy after the age of 75 years is associated with lower risk for MACE for both primary and secondary prevention.
Clinical Topics: Cardiac Surgery, Dyslipidemia, Geriatric Cardiology, Invasive Cardiovascular Angiography and Intervention, Prevention, Vascular Medicine, Cardiac Surgery and Arrhythmias, Nonstatins, Novel Agents, Statins, Interventions and Vascular Medicine
Keywords: Aged, 80 and over, Brain Ischemia, Geriatrics, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Ischemic Attack, Transient, Ischemic Stroke, Myocardial Infarction, Myocardial Ischemia, Myocardial Revascularization, Primary Prevention, Risk, Secondary Prevention, Stroke, Vascular Diseases
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