At what age should statin (3-hydroxy-3-methylglutaryl-coenzyme A reductase inhibitor) therapy be discontinued?

From the Guidelines

Statin therapy should not be automatically discontinued at any specific age, but rather, the decision to continue or stop statin therapy should be individualized based on several factors, including overall health status, life expectancy, goals of care, risk-benefit ratio, and patient preferences. For older adults, typically over 75 years, without cardiovascular disease, the benefits of statins for primary prevention become less clear, and discontinuation may be considered, as suggested by the 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol 1. However, for patients with established cardiovascular disease or very high cardiovascular risk, continuing statins into advanced age often remains beneficial, with recommendations to initiate or continue high-intensity statin therapy in patients 75 years of age or younger with clinical ASCVD 1.

Key factors to consider when deciding whether to discontinue statin therapy include:

• Overall health status and life expectancy
• Goals of care and patient preferences
• Risk-benefit ratio of continuing statin therapy
• Presence of cardiovascular disease or high cardiovascular risk
• Potential for adverse effects, such as polypharmacy, drug interactions, and changing kidney function
• Patient values and preferences, which should be weighed against the potential cardiovascular benefits of statin therapy

As patients age, regular reassessment of statin therapy is recommended, particularly when significant changes in health status occur or when patients develop conditions that might increase the risk of adverse effects, as stated in the guideline 1. The decision to discontinue statins should involve shared decision-making between the patient and healthcare provider, taking into account the individual's unique circumstances and priorities. In adults 75 years of age or older, it may be reasonable to stop statin therapy when functional decline, multimorbidity, frailty, or reduced life-expectancy limits the potential benefits of statin therapy 1.

From the Research

Discontinuation of Statin Therapy

There is no specific age at which statin therapy should be discontinued. The decision to stop statin therapy should be based on individual patient factors, such as overall health, cardiovascular risk, and life expectancy.

Factors to Consider

• The patient's overall cardiovascular risk, including factors such as diabetes, hypertension, hypercholesterolemia, and smoking 2, 3
• The patient's life expectancy and quality of life 3
• The presence of atherosclerotic cardiovascular disease (ASCVD) or risk factors for ASCVD 2, 3
• The patient's response to statin therapy and any potential side effects 4, 5

Age Considerations

• Age alone should not be a deterrent to statin therapy in older patients 3
• The US Preventive Services Task Force (USPSTF) recommends statin therapy for primary prevention of cardiovascular disease in adults aged 40 to 75 years with one or more cardiovascular risk factors and an estimated 10-year cardiovascular risk of 10% or greater 6
• The evidence is insufficient to determine the balance of benefits and harms of statin use for primary prevention of cardiovascular disease in adults 76 years or older with no history of cardiovascular disease 6

Key Points

• Statin therapy should be individualized based on patient factors, rather than age alone 2, 3
• The decision to discontinue statin therapy should be based on a patient-clinician discussion, taking into account the patient's overall health and cardiovascular risk 3
• There is no specific age at which statin therapy should be discontinued, and the decision to stop therapy should be based on individual patient factors 2, 3, 6, 4, 5