From the Guidelines
Deprescribing statins in adults 75 years of age or older may be reasonable when functional decline, multimorbidity, frailty, or reduced life-expectancy limits the potential benefits of statin therapy. This approach is supported by the 2019 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol, which suggests that in adults 75 years of age or older, it may be reasonable to stop statin therapy when these conditions are present 1. The decision to deprescribe statins should be made on an individual basis, taking into account the patient's overall health status, life expectancy, and potential benefits and harms of continuing statin therapy.
- Key considerations for deprescribing statins in older adults include:
- Functional decline or frailty
- Multimorbidity
- Reduced life expectancy
- Significant side effects, such as myalgia or cognitive issues
- Adherence challenges due to multiple medications
- When deprescribing is appropriate, a gradual dose reduction rather than abrupt discontinuation is recommended, with monitoring of lipid levels and cardiovascular symptoms 1.
- For patients with established cardiovascular disease, continuing statins often remains beneficial regardless of age, as the benefits of statin therapy in reducing cardiovascular risk outweigh the potential harms 1.
- Common statins include atorvastatin (10-80mg daily), rosuvastatin (5-40mg daily), and simvastatin (10-40mg daily), and the choice of statin and dose should be individualized based on the patient's specific needs and health status.
- The 2019 guideline also suggests that in adults 76 to 80 years of age with a LDL-C level of 70 to 189 mg/dL, it may be reasonable to measure coronary artery calcium (CAC) to reclassify those with a CAC score of zero and avoid statin therapy 1.
From the Research
Statin Deprescription in Older Adults
- The decision to deprescribe statins in older adults is complex and should be individualized based on the patient's overall risk of atherosclerotic cardiovascular disease (ASCVD) and other clinical factors that influence life expectancy and quality of life 2.
- Age alone should not be a deterrent to statin therapy in older patients, and the benefits of statin therapy should be weighed against potential risks and interactions with other medications 3, 2.
- Guidelines for statin use in primary prevention of cardiovascular disease in older adults are conflicting, and more research is needed to inform practice recommendations for this population 4.
Factors Influencing Statin Deprescription
- The presence of life-limiting comorbidities, functional decline, and other factors that influence life expectancy and quality of life should be considered when deciding whether to deprescribe statins in older adults 4, 2.
- Cardiac biomarkers and coronary calcium scoring can help identify older patients at higher ASCVD risk who may benefit from continued statin therapy 2.
- Potential drug interactions between statins and other lipid-modifying medications should be considered when making decisions about statin deprescription in older adults 5.
Evidence for Statin Benefits in Older Adults
- Observational studies suggest that statin therapy is associated with a lower risk of all-cause mortality, cardiovascular death, and stroke in older adults without prior cardiovascular disease 6.
- The benefits of statin therapy appear to persist even at higher ages (>75 years old) and in both men and women, although the evidence is rated as "very low" due to the observational nature of the studies 6.