Statin discontinuation after age 75 and cardiovascular risk in primary prevention
R Arbel, Y Raz, R Sergienko, B RonesAbstract
Background
Statins reduce cardiovascular events in primary prevention before age 75. Beyond this age, randomised evidence is limited, and guideline recommendations emphasise individualised decision-making. As a result, statin discontinuation at age 75 has become common practice despite limited outcome data. We hypothesized that discontinuation of statin therapy may increase the risk of major adverse cardiovascular events (MACE) in this population.
Purpose
To determine whether discontinuation of statin therapy in this population is independently associated with an increased risk of MACE compared with continued statin therapy.
Methods
We conducted a retrospective cohort study using longitudinal electronic health record data from Clalit Health Services, covering approximately two-thirds of the Israeli elderly population. Adults aged ≥75 years without established atherosclerotic cardiovascular disease and receiving statins for primary prevention were included. Patients were classified as continuation (reference) or discontinuation. The primary endpoint was MACE (acute myocardial infarction, ischaemic stroke, all-cause death). Secondary outcomes included each outcome separately. Inverse probability of treatment weighting using propensity scores, balanced baseline characteristics: demographics, comorbidities, lipids, blood pressure, body mass index, smoking status, and additional cardiovascular risk factors. Weighted Cox proportional hazards models estimated adjusted hazard ratios (HR) with 95% confidence intervals (CI).
Results
Among 71,439 eligible patients, 67,188 continued and 4,251 discontinued therapy. Incidence rates of MACE were 46 and 61 per 1,000 person-years in the continuation and discontinuation groups, respectively. Discontinuation was associated with an increased risk of MACE (adjusted HR 1.28; 95% CI 1.21–1.36; P<0.001). Associations were consistent across individual components (Figure 1).
Conclusions
In older adults receiving statins for primary prevention, discontinuation after age 75 was associated with higher cardiovascular risk. These findings support careful reassessment before routine deprescribing in this population.Forrest Plot