From the Guidelines
Aspirin and statins used for primary prevention can be discontinued in adults over 70 years old or when the risk-benefit ratio no longer favors their use, considering the increased risk of bleeding and side effects. When considering discontinuation of aspirin and statins, several factors should be taken into account, including the patient's age, bleeding risk, and cardiovascular risk factors. For aspirin, discontinuation should be considered in adults over 70 years old or those with increased bleeding risk, as the balance of benefits and risks is less favorable in this population 1. Aspirin should be tapered gradually over 1-2 weeks rather than stopped abruptly to avoid potential rebound cardiovascular events. For statins, discontinuation may be appropriate when side effects like significant myalgias, liver function abnormalities (ALT/AST >3 times normal), or severe drug interactions occur, as stated in the 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults 1. Additionally, statins might be reconsidered in patients with very limited life expectancy (less than 1-2 years) or when LDL cholesterol goals have been consistently achieved through lifestyle modifications. Before stopping either medication, a thorough cardiovascular risk reassessment should be performed, and the decision should involve shared decision-making between patient and provider, weighing individual cardiovascular risk against potential medication harms, as recommended in the 2022 standards of medical care in diabetes 1. Some key points to consider when deciding to stop aspirin and statins include:
- Patient's age and bleeding risk
- Cardiovascular risk factors, such as hypertension, dyslipidemia, and smoking
- Presence of side effects, such as myalgias or liver function abnormalities
- Patient's preferences and values
- Potential for rebound cardiovascular events after stopping aspirin Regular monitoring of lipid levels and cardiovascular risk factors should continue after discontinuation to ensure ongoing appropriate management. It is essential to consider the most recent and highest-quality study, which in this case is the 2022 standards of medical care in diabetes 1, to guide the decision-making process.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Aspirin and Statins for Primary Prevention
- Aspirin is not recommended for primary prevention of cardiovascular disease in patients with no overt cardiovascular disease, as the benefits are neutral or even harmful due to an increased risk of bleeding 2.
- Statins are recommended for primary prevention in high-risk patients, including those with severe hypercholesterolemia, diabetes with associated risk factors, and patients aged 40 to 75 years with a 10-year risk for atherosclerotic cardiovascular disease of 20% or greater 3.
Stopping Aspirin and Statins
- There is limited guidance on when to stop aspirin and statins for primary prevention, but it is suggested that aspirin can be stopped if the patient's risk of cardiovascular disease is low and the risk of bleeding is high 2.
- For statins, consideration of discontinuation may be given to patients with poor health status or short life expectancy, but current guidelines provide little specific guidance on this topic 4.
- The decision to stop statins should be based on individual patient factors, including their overall health status, life expectancy, and potential benefits and risks of continued treatment 4.
Considerations for Discontinuation
- When considering discontinuation of statins, factors such as statin intolerance, poor health status, and short life expectancy should be taken into account 4.
- The potential benefits of statin therapy, including reduction of cardiovascular risk, should be weighed against the potential risks, such as muscle and liver damage, new-onset diabetes mellitus, cognitive impairment, and haemorrhagic stroke 5.