News release

From: The Lancet

The Lancet Healthy Longevity: Stopping statins in adults over 75 with no history of heart disease or stroke does not increase the risk of death within three years; long-term follow up needed, finds trial

• Statins can be prescribed to adults at risk of, but with no history of, heart disease or stroke (called primary prevention) or to adults with established cardiovascular disease (secondary prevention). This study only looks at adults prescribed statins for primary prevention.

Stopping statins in adults aged 75 and older with no history of heart disease or stroke does not increase the risk of death over three years compared with continuing statins, although ‘bad’’ cholesterol rose around 50% in those who stopped, finds a randomised controlled trial published in The Lancet Healthy Longevity journal.

Statins are a key medication for the prevention of atherosclerotic cardiovascular disease, a specific type of cardiovascular disease caused by the buildup of fatty plaque (atherosclerosis) inside the arteries. In 2013, a Cochrane meta-analysis of 18 trials lasting up to five years reported a 14% reduction in deaths from all causes in adults taking statins for primary prevention of atherosclerotic cardiovascular disease with a median age of 57 years [1]. However, most trials looking at statins exclude individuals older than 70 or 80 years, therefore the benefit of statins for primary prevention of heart disease or stroke in older populations remains unclear.

This trial enrolled 1,160 adults aged 75 or older with no history of heart disease or stroke across general practices in France, randomly assigning them to either stop or continue their statin medication. 

After three years, 7.2% (35/484) of adults in the statin discontinuation group had died, compared with 7.9% (48/604) in the continuation group. There was no significant difference in major cardiovascular events, including heart attacks and strokes, between those who stopped statins and those who continued over the three years. However, after three months there was an average 50% increase (115 mg/dL to 171 mg/dL) in “bad” (LDL) cholesterol among the adults who stopped statins, while the group who continued taking statins had no change. Additionally, the study found measures of quality of life, both physical and mental, stayed the same for both groups during the three year follow-up.  

The authors say that benefits of statins increase over time in younger adults and it remains unknown whether stopping the medication could increase the risk of cardiovascular disease and death after the three-year follow-up period in older people. They caution that this study does not mean older patients with no history of heart disease or stroke should systematically stop taking their statins - the decision to continue or stop statin treatment in later life should be an individualised, shared decision-making process between patients and clinicians. Further trials are needed to confirm these findings and assess the long term effect of stopping statins in older adults. 

[1] https://pubmed.ncbi.nlm.nih.gov/23440795/