From the Guidelines
Atorvastatin should not be automatically discontinued in elderly patients based solely on age, but rather individual patient factors such as overall health status, life expectancy, and risk of cardiovascular disease should guide the decision. The decision to continue or discontinue atorvastatin in elderly patients should be based on a comprehensive assessment of the patient's health status, including their functional status, comorbidities, and life expectancy 1. For elderly patients who are generally healthy with good functional status and a life expectancy of several years, continuing atorvastatin for primary or secondary prevention of cardiovascular disease is often appropriate. However, for frail elderly patients with multiple comorbidities, limited life expectancy (less than 1-2 years), or those experiencing significant side effects, discontinuation may be reasonable 1.
Some key factors to consider when making this decision include:
- Overall health status and life expectancy
- Risk of cardiovascular disease
- Potential for adverse effects
- Patient values and preferences regarding cardiovascular risk reduction versus potential medication burden
- The benefit of statins may diminish in very advanced age (over 85-90), particularly for primary prevention, though secondary prevention benefits may persist 1.
Regular reassessment of the risk-benefit ratio is important, typically during annual wellness visits, to determine the best course of action for each individual patient 1. Any decision to discontinue atorvastatin should involve shared decision-making with the patient, considering their values and preferences regarding cardiovascular risk reduction versus potential medication burden.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Discontinuation of Atorvastatin in the Elderly
There is limited information available on the specific age at which atorvastatin can be discontinued in the elderly. However, the following points can be considered:
- The decision to discontinue statin treatment, including atorvastatin, in older adults should be based on individual patient factors, such as health status and life expectancy 2.
- Current international cardiovascular disease prevention guidelines provide little specific guidance for physicians who are considering statin discontinuation in older adults in the context of declining health status and short life expectancy 2.
- Some studies suggest that statin treatment can be continued in older adults with a high risk of cardiovascular events, but the benefits and risks of treatment should be carefully weighed in individual patients 3.
- The use of alternative lipid-lowering therapies, such as ezetimibe and PCSK9 inhibitors, may be considered in older adults who are intolerant of statins or have a high risk of cardiovascular events 4, 5, 3, 6.
Considerations for Discontinuation
When considering discontinuation of atorvastatin in the elderly, the following factors should be taken into account:
- The patient's overall health status and life expectancy 2.
- The presence of any comorbidities or conditions that may affect the patient's risk of cardiovascular events 3.
- The patient's ability to tolerate statin treatment, including any history of adverse effects or intolerance 6.
- The availability of alternative lipid-lowering therapies and their potential benefits and risks in individual patients 4, 5, 3, 6.