Should the Elderly Discontinue Statins?

For discussion with your doctor. Ask when primary prevention of inflammation in your arteries will be accomplished.  Statins are targeting a bystander, cholesterol, NOT the original problem which is inflammation. 

Should the Elderly Discontinue Statins?

The debate goes on, but Kevin Campbell, MD, believes every patient is different

The role of statin therapy in primary prevention of cardiovascular disease remains a subject of debate for patients older than age 75. While many studies suggest uncertainty about its efficacy and safety among older people, a recent study in the European Heart Journal suggests a strong association between hospital readmission and statin discontinuation in these patients. Kevin Campbell, MD, looks at all the studies and says, hang on, maybe the answer is not so cut and dried.
The opinions expressed in this commentary are those of the author. The following transcript has been edited for clarity:
Statins are good, right? We should put them in the drinking water just like fluoride for teeth, right?
As Lee Corso from ESPN says, not so fast, my friend. Statins have long been established as an effective form of secondary prevention in patients with known coronary artery disease. The use of statins in primary prevention for those older than 75 years of age, however, is far less well established. The data's everywhere.
In the last few years, there have been several published studies suggesting that statins are not necessary in patients over the age of 75. According to some, the risks of statins outweigh the benefits in older patients. The risk can be significant and may include falls, dementia, and myositis. According to one paper in The Lancet from 2019, statins do reduce vascular events in all age groups, but this reduction is much less pronounced in those over 75 without a history of prior vascular disease.
Many clinicians struggle every day about whether or not to take existing statin patients in this age group off therapy based on the currently available data. Most societies, including the ACC and AHA, recommend shared decision making in this subgroup of patients. Now, a new study published this past week in the European Heart Journal suggests that discontinuing statins in patients older than 75 years of age may actually increase the risk of hospital admissions by 33%. In this study that included almost 120,000 patients from France with a mean follow up to two and a half years, there was a strong association between hospital readmission and statin discontinuation. In fact, the association was far stronger for cardiac events than for all other vascular events such as a stroke, 46% and 26% respectively. So what the heck does all of this mean for us and our patients? Well, I believe this situation highlights what needs to change in medicine today.
We need to individualize treatments and provide each patient with the therapy best suited for them. It kind of all goes back to the dichotomy of using big data and predictive analytics to personalize care. As physicians, we need the time to both review the best available data and to understand the needs and unique features of each individual human being we treat. The current system, top heavy administrators and bean counters does not allow for that.
But back to the topic at hand, I digress. For me, the latest in a long line of statin studies simply says that we just don't know all we need to know when it comes to primary prevention in older patients. As always, we need to carefully select the best patients for each drug or therapy we use. If it's working and there are no side effects, I say continue the drug in this age group and continue to monitor for endpoints of safety and efficacy.
If the bad outweighs the good, then take action. Stop the medicine. At the core of medicine is the ability of the doctor to evaluate the risk-benefit ratio together with the patient and make the best decisions going forward.
I really don't think this study changes very much. We need to carefully consider whether it makes sense to remove a patient from a long standing well tolerated therapy. Maybe every new study does not mean that we need to completely change what we are doing and stop what is working for an individual patient. Let's consider each patient and their own needs. Let's be scientists. Let's certainly learn and respect new data. But first and foremost, let's be doctors.