Recent French research indicates that halting statin use at age 75 in individuals without a history of cardiovascular disease may be safe, following guidelines that now consider starting therapy as early as age 30. However, these findings may not be applicable in all regions.Â
The “non-inferiority” study, published Tuesday in the Lancet Healthy Longevity, does not recommend discontinuing statin prescriptions for the elderly, nor does it assert that stopping therapy is preferable. Instead, it suggests that patients consult their doctors to determine if they can safely discontinue the medication.
Emphasizing patient choice, the authors point out the scarcity of scientific research on older populations. Existing studies suggest that the connection between cholesterol and cardiovascular events diminishes with age. They propose that their study should be conducted over a longer duration and include groups with higher cardiovascular risk or those not as healthy as the current participants.
“For the majority of American patients over the age of 75, this trial will not change anything,” Romit Bhattacharya, a cardiologist from the Mass General Brigham Heart and Vascular Institute, told STAT in an interview. Although not involved in the study, he added, “It does give us a little bit of permission and greater flexibility and choice for our individuals who maybe have a short time horizon to live and who are already quite healthy and engaged in care.”
The randomized trial involved 1,160 patients from general practitioners’ offices across France, known for its universal health care and low cardiovascular mortality rate. Participants, averaging 80 years old, had been on statins for at least a year to prevent atherosclerotic cardiovascular disease, with most having taken them for over five years. High LDL cholesterol is a key point for discussing the prevention of artery plaque buildup.
Participants were divided into two groups and monitored for three years. After three months, LDL cholesterol levels increased by 50% (from 115 to 171 mg/dL) in those who ceased statin use, while the continuation group saw no change.
By the study’s conclusion, differences in outcomes were minimal. After three years, 7.2% (35 out of 484) in the discontinuation group had died, compared to 7.9% (48 out of 604) in the continuation group. These death rates are half the national average of 15% in France.
There was no significant difference in major cardiovascular events, such as heart attacks and strokes, between the two groups. Physical and mental quality of life measures remained consistent for both groups over the three-year period.
“This is a specific population, I think that’s the main point, and it has to be confirmed in other populations,” Fabrice Bonnet, a study co-author and professor at Bordeaux University Hospital, told STAT.
The authors expressed mild disappointment in finding no quality of life improvement from stopping statins, possibly because patients who disliked the drugs had already ceased using them. Randomly assigning participants to stay on or off the medication aimed to balance this factor.
This could explain why the study’s findings conflict with other non-randomized trials from 2021 in Denmark and Italy. Those studies indicated a 30% increased risk of cardiovascular outcomes after statins were stopped in older populations.
The Lancet study authors argue that previous trials lacked information on why participants stopped taking statins. Comparing two cohorts, instead of randomly assigning them, can introduce bias, as discontinuation may be due to other health risks, Bonnet and his co-authors noted.
Despite years of research failing to link most complaints to statins, they have a poor reputation for side effects. Known side effects include muscle pain in 1% of users and a slight increase in blood sugar levels, potentially leading to type 2 diabetes. However, a recent study found that 62 out of 66 side effects in the package insert do not hold up under scrutiny.
Since their introduction in 1987, statins have consistently reduced the risk of heart attacks and strokes by 25%.
Interest in deprescribing has grown alongside the increase in polypharmacy, where multiple medications manage conditions like blood pressure, heart failure, obesity, or diabetes in addition to cholesterol. Doctors are encouraged to review long-term medications, especially for older patients.
“The decision about statins should be an individualized decision, based on the patient’s expected longevity, comorbidities, understanding of potential risks, and personal preferences,” Donald Lloyd-Jones of the Boston University Chobanian & Avedisian School of Medicine told STAT, citing recent guidelines from AHA and other groups.
Age is a critical factor, Bonnet noted, especially considering diabetes, hypertension, social determinants of health, and smoking.
“If a patient is worried about the number of medications he’s been taking for years when he reaches 70 or 80 years old and the question of statins emerges, then you can be reassuring on stopping statins,” Bonnet said. “Cholesterol is no longer a high risk for elderly people. At 50 years old, it is, but at 75, it is no longer, when you have diabetes and hypertension.”
Careful evaluation is essential, according to Shefa Arya Nezhad, Parvaneh Rastgou, and Michael Nanna of the Yale School of Medicine, who wrote a commentary with the Lancet article.
“Deprescribing should not be confused with therapeutic nihilism,” they said. “The goal is not simply to reduce the number of medications, but to ensure that treatment remains aligned with an individual’s expected benefit, overall health status, and personal goals.”
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