For older patients who were treated with polypharmacy, discontinuing statins but not other therapies was found to increase the long-term risk for cardiovascular outcomes, according to results of a retrospective population-based cohort study published in JAMA Network Open.

Data for this study were sourced from the health care utilization databases in the Lombardy region in Italy. Individuals aged ³65 years (N=29,047) who were receiving polypharmacy (ie, antidiabetics, statins, blood pressure-lowering, and antiplatelet agents) between 2013 and 2015 were followed through 2018 for clinical outcomes.

A total of 18,273 individuals maintained their statin use, and 4203 discontinued statin use. These patient groups were aged mean 75.3 years (standard deviation [SD], 6.3) and 76.5 years (SD, 6.5), and 64.6% and 59.7% were men, respectively. In order to balance the cohorts, a subset of 4010 patients from each group were selected via propensity matching.


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After a mean follow-up of 20 months, patients who discontinued statin use had an increased frequency of hospital admissions for cerebrovascular disease (235 vs 208 events), heart failure (408 vs 337 events), and ischemic heart disease (439 vs 413 events); were admitted to an emergency department for any reason (2209 vs 2055 events); and had a higher mortality rate (528 vs 463 events) compared with patients who continued using statins, respectively.

Statin discontinuation was associated with an increased risk for heart failure hospitalization (hazard ratio [HR], 1.24; 95% CI, 1.07-1.43), all-cause mortality (HR, 1.15; 95% CI, 1.02-1.30), any cardiovascular outcome (HR, 1.14; 95% CI, 1.03-1.26), and admission to an emergency department (HR, 1.12; 95% CI, 1.05-1.19).

Stratified by demographics, risk for any cardiovascular outcome, all-cause mortality, or admission to an emergency department was not significantly associated with age, gender, number of comorbidities, or care setting.

This study may have been limited by not having access to data about health care obtained via private insurers or through out-of-pocket payment.

These data indicated that discontinuation of statins while maintaining use of other medications increased the risk for cardiovascular outcomes, emergency department admissions, and mortality. These negative outcomes were widespread among all patient populations regardless of demographic or clinical characteristics.

Disclosure: One study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

Reference

Rea F, Biffi A, Ronco R, et al. Cardiovascular outcomes and mortality associated with discontinuing statins in older patients receiving polypharmacy.JAMA Netw Open. Published online June 1, 2021.  doi:10.1001/jamanetworkopen.2021.