August 14, 2019
By Marilynn Larkin
NEW YORK (Reuters Health) - In people over age 75 with no history of cardiovascular disease, discontinuing statins was associated with increased risks of hospitalization for a cardiovascular event or stroke in an observational study.
"The study results suggest potential cardiovascular risk reduction associated with continuing statin therapy after the age of 75 years in persons already taking these drugs for primary prevention," Dr. Joel Coste of Assistance Publique-Hopitaux de Paris told Reuters Health by email.
"However," he stressed, "this is an observational, retrospective, non-randomized study and therefore it cannot show that discontinuing statins can cause a heart attack or stroke, only that it is associated with it."
Dr. Coste and colleagues studied French national databases, identifying 120,173 individuals (about 40% men) who turned 75 in 2012-2014 with no history of cardiovascular disease and who had been taking statins for at least two years.
Statin discontinuation was defined as three consecutive months without the drug.
As reported online July 30 in the European Heart Journal, 120,173 participants (about 40% men) were followed for an average of 2.4 years. Of the 17,204 (14.3%) who discontinued statins, 5,396 (4.5%) were hospitalized for a cardiovascular event.
Factors related to statin discontinuation were hospital admission during follow-up (adjusted odds ratio up to 3.28); admission to a skilled nursing home (aOR 2.66); metastatic solid tumor (aOR 2.22); and initiation of enteral or oral feeding (aOR 2.13).
Discontinuation of ACE inhibitors, ARBs, or aliskiren during follow-up also increased the probability of statin discontinuation (aOR 1.68); however, initiation of these drugs during follow-up as well as continuation of baseline use both decreased this probability (aOR 0.89 and 0.75, respectively).
With statin discontinuation, adjusted hazard ratios were 1.33 for any cardiovascular event; 1.46 for a coronary event; 1.26 for a stroke; and 1.02 for another vascular event.
Summing up, the authors state, "Statin discontinuation was associated with a 33% increased risk of admission for cardiovascular events in 75-year old primary prevention patients. Future studies...are needed to confirm these findings and support updating and clarification of guidelines on the use of statins for primary prevention in the elderly."
Dr. Coste noted several study limitations, including defining statin use by prescriptions dispensed ("However," he said, "as the patients regularly had prescriptions dispensed to them, they would be unlikely not to take the medication"); lack of baseline information on socio-economic status, lifestyles, tobacco use, obesity and frailty; and no precise information on why statins were stopped.
Nonetheless, he said, "extensive health-related patient information was used to improve the estimates of the association and the results are consistent with the known relationship between cholesterol levels and cardiovascular risk."
"Randomized studies are needed to confirm our findings and support updating of guidelines," he added. "One such study is ongoing - STAREE for STAtin Therapy for Reducing Events in the Elderly (https://clinicaltrials.gov/ct2/show/NCT02099123) - but its results will not be available until 2020, at best."
"Meanwhile," he concluded, "this study provides further reasons to continue statins after the age of 75 years in persons already taking these drugs for primary prevention."
Dr. Robert Greenfield, Medical Director of Non-Invasive Cardiology and Cardiac Rehabilitation at MemorialCare Heart and Vascular Institute at Orange Coast Medical Center in Fountain Valley, California, commented by email, "I individualize therapy for each patient taking into account factors such as other medications they take and other medical conditions that are being activity treated."
"For example, a patient over 75 years old who is already taking statins and having no adverse effects would be continued," he told Reuters Health. "However, if an elderly patient developed kidney failure, metastatic cancer, or other types of debilitating disorders, there is good evidence that statin therapy should be re-assessed."
"If statins were stopped for an appropriate medical reason, their discontinuation would be warranted," he said. "However, many patients may decide on their own not to take statins based on faulty information or perceived side effects, and this could increase their cardiovascular risk".
Statins are both plaque stabilizers and anti-inflammatory, he added. "Atherosclerosis is an inflammatory disease and removing the beneficial actions of statins can destabilize the plaque and cause it to grow or rupture, which can produce a heart attack or stroke. In primary prevention, patients haven't yet experienced any cardiovascular complication, but it only takes one plaque rupture to change your life."
Eur Heart J 2019.
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