Some older adults can safely stop taking statin therapy for primary prevention after turning 75, according to a study from France.
The trial, published in July in The Lancet Healthy Longevity, offers the newest evidence on whether it is safe to stop taking a statin after a certain age if you’ve never had a heart attack or stroke. French researchers found that adults aged 75 and older who stopped the medication were no more likely to die over the next three years than those who kept taking it.
However, contrary to what many doctors and patients might expect, stopping didn’t improve how people felt, either—their quality of life, physical and mental functioning, and symptoms stayed about the same as those who stayed on the drug.
“We sometimes assume that deprescribing will automatically make patients feel better, but among people who had already tolerated a statin for years, that was not the case,” Dr. Michael Nanna, a cardiologist at Yale School of Medicine and corresponding author of an accompanying commentary published in The Lancet Healthy Longevity, told The Epoch Times via email.
What Happened When They Stopped?
Researchers followed 1,160 adults with an average age of about 80, none of whom had a history of heart disease. Half were randomly assigned to keep taking their statin, and half stopped.
After three years, the two groups looked very similar: 7.2 percent of people who stopped taking statins had died, compared with 7.9 percent of those who continued taking the medication—a difference small enough for researchers to call stopping “non-inferior” to continuing them, meaning that it didn’t raise the risk of death beyond a threshold they’d set in advance.
Researchers found no meaningful difference in quality of life. People who stopped didn’t report feeling better, physically or mentally, than those who stayed on the drug.
Rates of muscle problems, diabetes, cognitive issues, and serious infections didn’t differ significantly between groups either.
One number did move sharply: Low-density lipoprotein (LDL), the “bad” cholesterol that contributes to plaque buildup in the arteries, rose by about 50 percent among those who stopped–from roughly 115 milligrams to 171 milligrams per deciliter over three years. Heart attacks were also more common in the group that stopped: 2.1 percent had a heart attack, compared with 1.4 percent of those who continued, although the study was too small to determine whether that difference reflected a real increase in risk or was simply due to chance.
“The easiest way to misread this trial is as showing that once someone turns 75, it no longer matters if they take a statin,” Nanna said.
For adults aged 75 and older with no existing heart disease, the U.S. Preventive Services Task Force says there is insufficient evidence to recommend statin therapy.
Why 75 Isn’t a Magic Cutoff
Statins lower LDL cholesterol, which over time can slow the buildup of fatty plaques inside arteries and reduce the chance that one of those plaques will trigger a heart attack or stroke.
However, that protection takes years to pay off—and how much it’s worth depends partly on how long a person is likely to live and what other health conditions may affect them first.
“For older adults hoping to prevent a first heart attack or stroke, the decision hinges on time to benefit and competing risks,” Dr. Karen Alexander, a cardiologist and professor of medicine at Duke University, who was not involved in the study, told The Epoch Times via email.
Older adults differ enormously in their health. Studies show that older people have greater individual differences than middle-aged or younger people. An active 85-year-old with high cardiovascular risk may stand to gain more from staying on a statin than a 75-year-old with advanced illness or severe frailty.
“The decision should fit the person, not their date of birth,” Nanna said.
The researchers say their findings need confirmation in larger studies with longer follow-up and in older adults at higher cardiovascular risk or less healthy than the participants in this trial.
When Stopping Makes Sense
Knowing when to stop a preventive medication is one of the trickier calls in geriatric care, and this study doesn’t apply to everyone. It excluded anyone who’d already had a heart attack, stroke, or other established cardiovascular disease; for those patients, the case for staying on a statin remains stronger.
For some older adults who do decide to stop, taking one fewer medication may make treatment simpler and reduce the potential for drug-to-drug interactions. And Nanna said the conversation should go both ways: Clinicians should “explain the uncertainty honestly, and ask what matters most to the patient.”
For people taking statins to prevent a first cardiovascular event, doctors weigh factors such as diabetes, blood pressure, smoking history, cholesterol levels, kidney disease, family history—sometimes alongside imaging that shows how much plaque, if any, has built up in a patient’s arteries.
They also consider how well a person can handle the medication, whether it might interact with other drugs they’re taking, how many other prescriptions they’re on, if they’re frail, and how well they are physically and mentally.
“For someone aged 75 or older who has not yet had a heart attack or stroke, but who needed to be on a statin before age 75 because of elevated risk, continuing the statin makes sense, unless there is a life-limiting illness,” Dr. Ariela Orkaby, a geriatrician and researcher at Brigham and Women’s Hospital, who was not involved in the study, told The Epoch Times via email.
Bigger questions remain open, too. Orkaby noted that researchers still don’t fully understand whether statins offer older adults other benefits beyond heart protection.