Statin Discontinuation Improves Quality of Life in Palliative Care Setting
In patients with poor prognoses at the end of life, emphasis is often placed on maintaining quality of life over longevity, which may entail discontinuing medications that have adverse side effects. A high percentage of older adults who are prescribed statins for lowering cholesterol levels experience adverse effects of statins, which may include minor discomfort, such as muscle and joint aches, nausea, diarrhea or constipation, or effects leading to more serious issues, such as liver damage, musculoskeletal pain (eg, statin myopathy, rhabdomylosis), and blood glucose spikes in patients with type 2 diabetes. To determine the benefits of statin discontinuation in the palliative care setting, a team of investigators conducted a multicenter, parallel-group, unblended trial that involved patients whose prognoses ranged between 1 month and 1 year. Their results were published recently in JAMA Internal Medicine (https://bit.ly/JAMA_Statins).
The trial included a total of 381 patients who had been on statin therapy for at least 3 months for primary or secondary prevention of cardiovascular disease, no recent active cardiovascular disease, and a recent deterioration in functional status. The participants had a mean age of 74.1 years; 22% were cognitively impaired, and almost half had cancer (48.8%). About half of the participants were randomly assigned to discontinue statin therapy. Approximately 24% of participants who discontinued therapy died within 60 days, compared with 20% of participants who continued therapy; this difference did not reach statistical significance. Total quality of life (QOL), which was assessed according to the McGill score, was better for the group discontinuing statin therapy (mean McGill QOL score, 7.11 vs 6.85; P=.04). Few participants experienced cardiovascular events (13 in the discontinuation group vs 11 in the continuation group). The trial also looked at cost savings: the mean savings for discontinuing statins in this group were $3.37 per day and $716 per patient.
Based on these results, the investigators concluded in their study that discontinuation of statin medication in patients with poor prognoses is safe and may yield other benefits, including improved QOL and reduction in medication costs. “Thoughtful patient-provider discussions regarding the uncertain benefit and potential decrement in QOL associated with statin continuation in this setting are warranted,” they wrote.
