CV Effect of Discontinuing Statins at Age 75 Years

Study Questions:

What is the impact of discontinuing statin therapy on cardiovascular events (CVEs) in previously adherent 75-year-old patients treated for primary prevention?

Methods:

The authors conducted a population-based cohort study using French national healthcare databases in all subjects who turned 75 years old in 2012-2014, with no history of CV disease and with statin possession ratio ≥80% in each of the preceding 2 years. Statin discontinuation was defined as 3 consecutive months without exposure. Outcome variable was hospitalization for any CVE. The hazard ratio (HR) comparing those discontinuing versus continuation was estimated using a model adjusting for baseline and time covariates including duration of statin use, comorbidities, and frailty indicators.

Results:

A total of 120,173 subjects were included with a mean duration follow-up of 2.4 years (maximum 4 years); 14.3% discontinued statins and 5,396 (4.5%) were admitted for CVEs, which corresponds to 2.1 per 100 patient-years. The adjusted HR for statin discontinuation was 1.33 (95% confidence interval, 1.18-1.50) for any CV event; 1.46 (1.21-1.75) for coronary events, 1.26 (1.05-1.51) for any cerebrovascular event, and 1.02 (0.74-1.40) for other vascular events.

Conclusions:

Statin discontinuation was associated with a 33% risk of admission for CVEs in 75-year-old primary prevention patients. Future studies, including randomized studies, are needed to confirm these findings and support updating and clarification of guidelines for use of statins for primary prevention in the elderly.

Perspective:

The 14.5% discontinuation rate is much lower (about two thirds) than in most studies, but was limited to those who had been compliant for at least 2 years. Among the strengths included adjustment for continuing nonstatin CV drug therapies, hospital or skilled nursing care admission, metastatic cancer, and change in nutrient feeding. Limitations included lack of reason for discontinuation, low-density lipoprotein cholesterol at baseline or on statin treatment, tobacco use, and frailty markers.

Clinical Topics: Dyslipidemia, Geriatric Cardiology, Prevention, Lipid Metabolism, Nonstatins, Novel Agents, Statins

Keywords: Cholesterol, LDL, Comorbidity, Frail Elderly, Geriatrics, Hospitalization, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Patient Compliance, Primary Prevention, Tobacco Use, Vascular Diseases


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