Should we be prescribing or stopping statins in people over eighty years?
Statin use is controversial, especially for very old people. Do older patients benefit from starting or continuing statin treatment to prevent cardiovascular disease (CVD)? Should very old people discontinue statin treatment that they may have begun when younger? We have limited evidence to answer these questions because most randomised controlled trials have focused on people aged younger than 80 years old.
The safety of statin treatment is also an important consideration. Side effects from statins may include muscle pains and muscle weakness, which might contribute to reduced quality of life and loss of function making this quite an issue in managing CVD risk in older people.
In our recent study from King’s College London, published in Age and Ageing, we investigated current practice by analysing rates of starting statin prescription and rates of discontinuation in people aged 80 years and over. We analysed electronic health records data for a cohort of 212,566 participants aged ≥80 years registered with UK general practices. The sample was drawn from the UK Clinical Practice Research Datalink. We classified frailty using Andrew Clegg’s e-Frailty Index.
We found that the proportion of men over 80 using statins increased from 12% in 2001 to 55% in 2015 and from 9% to 46% in women. Even among centenarians, 12% were prescribed statins.
Statin prescribing was more frequent for frail individuals and people with secondary prevention indications, including pre-existing heart disease, stroke or diabetes. Note that these conditions contribute to the e-Frailty Index.
New use of statins (inception) was quite infrequent in the over-80s. The rate of statin inception was 2.4% per year and decreased with increasing age.
We defined statin deprescribing as a last ever statin prescription more than 6 months before the end of participant records.
The rate of statin deprescribing was 5.6% per year overall. The rate of deprescribing increased with age, reaching 17.8% per year in centenarians. Deprescribing increased with frailty level being 5.0% per year in ‘fit’ participants and 7.1% in ‘severe’ frailty.
Our results appear paradoxical. We find that statin use has increased rapidly in very old people. This reflects the widespread use of statins at younger ages, which is now being carried over into older ages. Conversely, we find that it is quite uncommon for people over 80 to start statins. At this age, statins are gradually being discontinued – a process that increases with age.
These paradoxical findings highlight uncertainty concerning appropriate use of statins in the over-80s and the need for better evidence to inform clinical practice with respect to statin use and discontinuation for people aged ≥80 years.
Research Associate, King’s College, London
Read the Age and Ageing paper