From the Guidelines
Deprescribing statins in elderly patients should be considered when the potential risks outweigh the benefits, particularly in those with limited life expectancy, frailty, or significant cognitive decline. For patients over 75 years of age without established cardiovascular disease, it is reasonable to discontinue statins like atorvastatin, rosuvastatin, or simvastatin, especially if they are experiencing side effects, have limited life expectancy (less than 1-2 years), or have developed frailty, significant cognitive decline, or functional impairment 1. The deprescribing process should be gradual, with dose reduction over 4-8 weeks before complete discontinuation, while monitoring lipid levels and cardiovascular symptoms.
Key Considerations
- The decision to deprescribe statins should be individualized, taking into account the patient's goals of care, quality of life priorities, and life expectancy 1.
- Patients with recent cardiovascular events or high-risk conditions may still benefit from continuing statins, requiring careful assessment of the risk-benefit profile 1.
- The time to benefit of statin therapy should be considered, as well as the potential for adverse effects, such as myopathy and cognitive issues 1.
Deprescribing Approach
- Gradually reduce the statin dose over 4-8 weeks before complete discontinuation.
- Monitor lipid levels and cardiovascular symptoms during the deprescribing process.
- Consider alternative treatments or lifestyle modifications to manage cardiovascular risk factors.
Rationale for Deprescribing
- Diminished preventive benefit in advanced age.
- Increased risk of drug interactions due to polypharmacy.
- Higher susceptibility to adverse effects.
- Changing risk-benefit profiles as life expectancy decreases 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Deprescribing Statins in the Elderly
- The decision to deprescribe statins in older adults is complex and depends on various factors, including the patient's health status, life expectancy, and potential benefits and harms of continuing statin therapy 2.
- Current international cardiovascular disease prevention guidelines provide little specific guidance for physicians considering statin discontinuation in older adults in the context of declining health status and short life expectancy 2.
- A meta-analysis found that using statins to reduce mortality in frail patients does not appear justifiable, and further prospective studies are needed to guide statin use among frail older adults for survival benefits 3.
Considerations for Deprescribing Statins
- Triggers to deprescribe statins include present or expected adverse drug reactions, unnecessary polypharmacy, and the need to align medications with goals of care when life expectancy is reduced 4.
- Adverse drug reactions are a common reason for deprescribing cardiovascular medications, including statins, in older adults 5.
- Geriatricians are more likely to consider deprescribing statins in cases of limited life expectancy, such as recurrent metastatic cancer, Alzheimer dementia, or significant functional impairment, compared to general internists and cardiologists 5.
Comparative Efficacy of Different Statins
- A post hoc analysis found minimal differences in cardiovascular disease outcomes and no significant difference in persistent physical disability between various forms of statins in healthy older adults 6.
- High-potency statin use (atorvastatin and rosuvastatin) was marginally associated with lower risk of fatal cardiovascular disease events compared with low-/moderate-potency statin use 6.
Barriers to Deprescribing Statins
- Barriers to deprescribing cardiovascular medications, including statins, are shared across specialties and include concerns about interfering with other physicians' treatment plans and patient reluctance 5.
- Implementing deprescribing will require improved processes for both physician-physician and physician-patient communication 5.