Geriatrics

The study, which is published in the European Heart Journal , is the first to evaluate the impact of discontinuing statins taken for primary prevention in older people. Dr Philippe Giral, an endocrinologist specialist in prevention of cardiovascular disease at Pitié-Salpêtrière Hospital (part of Assistance Publique-Hôpitaux de Paris), Paris, France, who led the research said that although further, randomized studies are needed before guidelines can be updated, he would advise elderly people who are taking statins to prevent cardiovascular disease to continue taking them.

Prevention in older people

“To patients, we would say that if you are regularly take statins for high cholesterol; they would recommend you don’t stop the treatment when you are 75. To doctors, we would recommend not stopping statin treatment given for primary prevention of cardiovascular diseases in your patients aged 75;” he said. The researchers analyzed data from the French national health insurance claims database and information on hospital diagnoses and clinical procedures.

They were able to get comprehensive information on statin use; especially as statins are available by prescription only; for the whole of the French population. They looked specifically at all patients who had turned 75 between 2012 and 2014; who had been taking statins for at least 80% of the time in the previous two years. They included only people with good cardiovascular health in the analysis. They excluded all those who had been diagnosed with cardiovascular disease and anyone who was taking other medications to treat or prevent heart or blood vessel problems.

Diagnoses and clinical procedures

The researchers followed the 120,173 patients for a maximum of four years (an average of 2.4 years). During this time 14.3% (17,204 people) stopped taking statins for at least three consecutive months; and 4.5% (5,396 people) are admit to hospital for a cardiovascular problem. Those who discontinue their statins had a 33% increased risk of any cardiovascular event. The association is stronger for admissions to hospital for heart problems; there was a 46% increase risk of a coronary event; while the increased risk of a blood vessel problem, such as stroke; was 26%.

Dr Giral says: We estimate that an extra 2.5 cardiovascular events per 100 people  occur within four years among those who discontinue their statins at the age of 75 years compare to those who continue taking their statins.” The researchers stress that this is an observational; retrospective, non-randomis study and therefore cannot show that discontinuing statins  cause a heart attack or stroke, only that it is associate with it. However; they say that extensive health-relate patient information is use to improve their estimates of the association and their results are consistent with the know relationship between cholesterol levels and cardiovascular risk.