Statins should not be stopped in older people owing to their benefits, say researchers

People aged over 80 years who stop taking statins may have substantially reduced protection against cardiovascular disease (CVD), suggests a large data analysis from over 150,000 people.

The modelling study, carried out by researchers from Queen Mary University of London, the University of Oxford and the University of Sydney, found that people with lower CVD risk (less than 5% over 10 years) who started taking statins in their 50s but stopped at 80 years of age, instead of continuing life-long, lost 73% of their potential benefit, measured in quality-adjusted years of life (QALYs).

In contrast, people at high CVD risk (20% over 5 years or more) who stopped statins aged 80 years, instead of continuing life-long, lost only 36% of the potential benefit, as people at higher risk tend to benefit earlier.

Women appeared to lose more benefit in the modelling by stopping statins at 80 years, compared with men (66% vs. 47%).

The study adds to the evidence on polypharmacy as people age, particularly as some older people may question whether they need to continue taking preventive medicines which do not control symptoms but reduce their risk of CVD.

The study, which will be presented at the ESC Congress in Barcelona on Saturday 27 August 2022, used individual characteristics and history of medical conditions to simulate people’s annual risk of cardiovascular events, diabetes, cancer and death.

The researchers then estimated the effect of treatment with a standard dose of statin (40mg daily). They calculated the effects of statins used lifelong; statins stopped at 80 years; and statin initiation delayed by 5 years in people aged under 45 years. The study found that much of the gain in QALYs from statin therapy happened later in life, especially for people with lower overall cardiovascular risk. However, people at low cardiovascular risk did not lose benefit by starting statins later. A 5-year delay from age 45 years made little difference to people’s overall potential QALY benefit.

Lead author Dr Runguo Wu, health economist at the Queen Mary University of London, said: “Stopping treatment, unless advised by a doctor, does not appear to be a wise choice.

“Women’s cardiovascular risk is generally lower than men’s. This means that for women, most of the life-long benefit from statins occurs later in life and stopping therapy prematurely is likely more detrimental than for men.”

Helen Williams, consultant pharmacist for CVD at South East London Integrated Care System and national specialty adviser for CVD prevention at NHS England, said the study added to mounting evidence that statins can be beneficial for people in older age groups.

“Obviously it needs to be a shared decision. One of the challenges with deprescribing is we want to deprescribe those drugs that are inappropriate, but these studies show there is a risk around cardiovascular events and patients need to be aware of that risk.

“If [statins] are causing problems or side effects, that needs to be addressed, but hopefully that’s happened before they are 80. Ideally, patients would stay on them if they are not causing them problems. [Deprescribing] isn’t necessarily a good idea.”

Williams said questions about cardiovascular drugs often come up during medicine reviews. “People question what the long-term value is — but now there have been two or three studies and we can see it does have an impact.”

She pointed out that the National Institute for Health and Care Excellence recommends statins should be considered for cardiovascular risk reduction for people over the age of 85 years, and says statin prescription needs to be a personalised choice, whatever age people are. “85 year-olds are very different — some are running marathons, some are in nursing homes,” she said.

Previous studies have shown that stopping statins for older people can be detrimental. A 2019 French study found people aged 75 years who stopped statins had a 33% increased risk of hospital admission for a cardiovascular event, and a 2021 Italian study found people aged 65 years and over taking multiple medications had a 24% increase in hospital admissions for heart failure if they stopped statins while maintaining other medications.