Recommendations for (Discontinuation of) Statin Treatment in Older Adults: Review of Guidelines

Milly A van der Ploeg; Carmen Floriani; Wilco P Achterberg; Jonathan M K Bogaerts; Jacobijn Gussekloo; Simon P Mooijaart; Sven Streit; Rosalinde K E Poortvliet; Yvonne M Drewes

doi:10.1111/jgs.16219

Recommendations for (Discontinuation of) Statin Treatment in Older Adults: Review of Guidelines

J Am Geriatr Soc. 2020 Feb;68(2):417-425. doi: 10.1111/jgs.16219. Epub 2019 Oct 30.

Authors

Milly A van der Ploeg¹, Carmen Floriani², Wilco P Achterberg¹, Jonathan M K Bogaerts¹, Jacobijn Gussekloo^{1

3}, Simon P Mooijaart³, Sven Streit², Rosalinde K E Poortvliet¹, Yvonne M Drewes³

Affiliations

¹ Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands.
² Institute of Primary Health Care (Berner Institut für Hausarztmedizin, BIHAM), University of Bern, Bern, Switzerland.
³ Department of Internal Medicine, Section Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands.

Abstract

Objectives: As a person's age increases and his/her health status declines, new challenges arise that may lead physicians to consider deprescribing statins. We aimed to provide insight into recommendations available in international cardiovascular disease prevention guidelines regarding discontinuation of statin treatment applicable to older adults.

Design: We systematically searched PubMed, EMBASE, EMCARE, and the websites of guideline development organizations and online guideline repositories for cardiovascular disease prevention guidelines aimed at the general population. We selected all guidelines with recommendations (instructions and suggestions) on discontinuation of statin treatment applicable to older adults, published between January 2009 and April 2019. In addition, we performed a synthesis of information from all other recommendations for older adults regarding statin treatment. Methodological quality of the included guidelines was appraised using the appraisal of guidelines for research & evaluation II (AGREE II) instrument.

Results: Eighteen international guidelines for cardiovascular disease prevention in the general adult population provided recommendations for statin discontinuation that were applicable to older adults. We identified three groups of instructions for statin discontinuation related to statin intolerance, and none was specifically aimed at older adults. Three guidelines also included suggestions to consider statin discontinuation in patients with poor health status. Of the 18 guidelines included, 16 made recommendations regarding statin treatment in older adults, although details on how to implement these recommendations in practice were not provided.

Conclusion: Current international cardiovascular disease prevention guidelines provide little specific guidance for physicians who are considering statin discontinuation in older adults in the context of declining health status and short life expectancy. J Am Geriatr Soc 68:417-425, 2020.

Keywords: cardiovascular diseases; clinical decision making; drug therapy; hydroxymethylglutaryl-CoA reductase inhibitors; prevention.

Publication types

Research Support, Non-U.S. Gov't
Systematic Review

MeSH terms

Age Factors
Aged
Aged, 80 and over
Cardiovascular Diseases / prevention & control
Female
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors / administration & dosage
Hydroxymethylglutaryl-CoA Reductase Inhibitors / adverse effects*
Male
Practice Guidelines as Topic*
Withholding Treatment

Substances

Hydroxymethylglutaryl-CoA Reductase Inhibitors