Benefits of Continuing Statins for Primary Prevention in Older Adults

Older adult patients, 75 years of age and older, who discontinue statin therapy for primary prevention are at increased risk of admission for cardiovascular events, according to researchers of a recent study. The study findings were published online in the European Heart Journal.

“The role of statin therapy in primary prevention of cardiovascular disease in persons older than 75 years remains a subject of debate with little evidence to support or exclude the benefit of this treatment,” explained lead researcher Philippe Giral, MD, PhD, Hôpital Pitié-Salpêtrière, and colleagues. “We assessed the effect of statin discontinuation on cardiovascular outcomes in previously adherent 75-year-olds treated for primary prevention.”

For the study, Dr Giral and colleagues conducted a population-based cohort study using French national health care databases. The study participants included adults who turned 75 between 2012 and 2014 with a statin medication possession ration ≥80% in each of the previous 2 years and no history of cardiovascular disease.  

The research team defined station discontinuation as 3 consecutive months without exposure, and the primary outcome of the study was hospital admission for a cardiovascular event. 

“The hazard ratio comparing statin discontinuation with continuation was estimated using a marginal structural model adjusting for both baseline and time-varying covariates (cardiovascular drug use, comorbidities, and frailty indicators),” Dr Giral and colleagues noted.

The research team identified 120,173 study participants who were followed for an average of 2.4 years. Of the 120,173 participants, 17,204 (14.3%) discontinued statins, and 5396 (4.5%) were admitted for a cardiovascular event. 

According to the findings, the adjusted hazard ratio for statin discontinuation were as follows:

• 1.33 [95% confidence interval (CI) 1.18–1.50] (any cardiovascular event);
• 1.46 (95% CI 1.21–1.75) (coronary event);
• 1.26 (95% CI 1.05–1.51) (cerebrovascular event); and,
• 1.02 (95% CI 0.74–1.40) (other vascular event).

“Statin discontinuation was associated with a 33% increased risk of admission for cardiovascular event in 75-year-old primary prevention patients,” the study authors concluded. “Future studies, including randomized 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.”

—Julie Gould

Reference:

Giral P, Neumann A, Weill A, Coste J. Cardiovascular effect of discontinuing statins for primary prevention at the age of 75 years: a nationwide population-based cohort study in France [published online July 31, 2019]. Euro Heart J. doi: https://doi.org/10.1093/eurheartj/ehz458