Background: In the UK, statins are commonly prescribed for early prevention of cardiovascular diseases (CVD) when critical risk factors have been identified in primary care consultation (e.g., high levels of LDL-Cholesterol and CVD scores). After the first prescription, it is expected that people continue treatment for lifetime. Guidelines provide standard criteria on when to start statins prescription, but there is no general standard on when to stop the preventive medication. Indeed, there is a lack of information on what typically occurs in later life to patients who discontinued statins. Stopping statins might be an indicator of individuals being close to end of life.
Objectives: To evaluate time-to-death from the last statins prescription in patients registered in the UK primary care, comparing survival between older and younger populations.
Methods: Retrospective cohort study. Using UK primary care data (IMRD) from >600 general practices, we evaluated individuals aged 40 to 99 between 2006 and 2018 who were prescribed statins regularly. Using a Cox regression, we estimated survival up to 5 years of observation since the last statin prescription. We compared survival between age categories (40-50, 50-60, 60-70, 70-80, 80-90, 90-99 years old) and estimated hazard ratios (HR) using people aged 60-70 years as the reference group. Models were fitted by sex, and HR adjusted for social deprivation (Townsend score).
Results: We identified 61,223 individuals, 32,784 were men (53.5%), and 28,439 were women (46.5%). The youngest men and women (40-50 years old) were less likely to die after statin discontinuation (HR(men)=0.26; 95%CI 0.19-0.35; HR(women)=0.39; 95%CI 0.26-0.59), compared to the 60-70 years age group. Conversely, the oldest men and women (90-99) were more likely to die (HR(men)=6.53; 95%CI 5.31-8.03; HR(women)=10.08; 95%CI 8.46-12.02). Most of those who died, died within the first year of discontinuation; thus, 41% of men and 40% of women aged 90-99 died. Among people aged 80-90, 31% of men and 22% of women died, while among people aged 70-80, 14% of men and 9% of women died. After two years of discontinuation, nearly half of men and women aged 90-99 had died, while 38% of men and 27% of women aged 80-90 died, and 18% of men and 11% of women aged 70-80 died. In general, people who discontinued statins before they were 70 years old survived for longer during the 5 years of observation.
Conclusions: Our findings suggest that stopping statin treatment could be a marker of patients who are near the end of life. Thus, half of the individuals aged 90 and above died within two years of discontinuation. Among individuals aged 70-89, men were more likely to die soon after they had stopped treatment.
