The Elderly and Polypharmacy: What to Discontinue

We often receive elderly poly-medicated patients (with more than 10 different drugs) who ask us to reassess these prescriptions and, if possible, discontinue some drugs. The reasons are many: they forget to take it, mix up intakes or drugs, and of course, most often find it expensive. 

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Statins are one of the most expensive drugs and when the patient has never presented a cardiovascular event (primary prevention) the temptation to discontinue can be irresistible. According to this study, statin discontinuation is a fatal mistake that might lead to a cardiovascular event in 1 every 3 patients with these characteristics. 

This analysis conducted by Dr. Philippe Giral and recently published in the European Heart Journal showed statin discontinuation is associated to 33% of cardiovascular risk in patients over 75 that take them as primary prevention. 

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The study rationale is based on the fact that primary prevention with statins in patients over 75 has no evidence to support it but has a high cost for the healthcare system. 

This cohort of 120173 patients over 75 with no history of CAD had received statins for at least 2 years before inclusion and were followed up at mean 2.4 years. Discontinuation was defined as no drug intake for 3 consecutive months. 

During follow up, 14.3% discontinued statins and 4.5% were admitted for a major cardiovascular event. 

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Adjusted risk for statin discontinuation was 1.33 for any cardiovascular event, 1.46 for a coronary event, 1.26 for a cerebrovascular event and 1.02 (not significant) for vascular events. 


Statin discontinuation was associated to a 33% increased risk of cardiovascular events in elderly patients receiving medication in the context of primary prevention.

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Original Title: Cardiovascular effect of discontinuing statins for primary prevention at the age of 75 years: a nationwide population-based cohort study in France.

Reference: Philippe Giral et al. European Heart Journal (2019) 40, 3516–3525.

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