At what age should statin (HMG-CoA reductase inhibitor) therapy be discontinued?

From the Guidelines

The decision to stop statin therapy should be individualized, but generally, statins may be considered for discontinuation in adults over 75 years old, particularly if they have developed significant side effects or limited life expectancy, as stated in the 2013 ACC/AHA guideline 1. When considering stopping statin therapy, several factors should be taken into account, including overall health status, life expectancy, quality of life, and the risk-benefit ratio.

• The risk of drug interactions and side effects increases with age, while the time needed to see benefits from statins may exceed remaining life expectancy.
• For healthy older adults with good functional status and life expectancy, continuing statins may still be beneficial, especially if they have established cardiovascular disease or multiple risk factors, as recommended by the 2017 AHA/ACC clinical performance and quality measures 1.
• The 2013 ACC/AHA guideline recommends that high-intensity statin therapy should be initiated or continued as first-line therapy in women and men ≤75 years of age who have clinical ASCVD, unless contraindicated 1.
• In individuals with clinical ASCVD >75 years of age, it is reasonable to evaluate the potential for ASCVD risk-reduction benefits and for adverse effects, drug-drug interactions, and to consider patient preferences when initiating a moderate- or high-intensity statin, as stated in the 2017 AHA/ACC clinical performance and quality measures 1. Before stopping statins, patients should always consult with their healthcare provider to discuss their specific situation, as abrupt discontinuation could potentially increase cardiovascular risk in some individuals, and regular reassessment of statin therapy is important as a person ages to ensure the medication remains appropriate for their changing health status.

From the Research

Statin Therapy and Age

• The decision to stop statin therapy is complex and depends on various factors, including the patient's age, cardiovascular risk factors, and overall health status 2, 3.
• According to the US Preventive Services Task Force (USPSTF), the evidence is insufficient to determine the balance of benefits and harms of statin use for the primary prevention of CVD events and mortality in adults 76 years or older with no history of CVD 2.
• A study published in JAMA found that statin therapy was associated with reduced risk of all-cause mortality and CVD events in adults at increased CVD risk but without prior CVD events, but the data for persons older than 75 years were sparse 4.
• Another study published in The Medical clinics of North America noted that uncertainty exists in those older than 75 years who may be more likely to benefit from statin therapy because of their underlying CVD risk, but also face uncertain harms 3.

Considerations for Stopping Statin Therapy

• When considering stopping statin therapy, clinicians should weigh the potential benefits and harms of continued treatment, taking into account the patient's individual risk factors and health status 5, 6.
• A systematic review of the evidence found that non-adherence and discontinuation of statin therapy significantly increased the incidence of cardiovascular and cerebrovascular events as well as all-cause mortality in high-risk patients 6.
• The USPSTF recommends that clinicians prescribe a statin for the primary prevention of CVD for adults aged 40 to 75 years who have 1 or more CVD risk factors and an estimated 10-year CVD risk of 10% or greater, but the recommendation is less clear for adults over 75 years old 2.