Inception and deprescribing of statins in people aged over 80 years: cohort study

TY - JOUR

T1 - Inception and deprescribing of statins in people aged over 80 years

T2 - cohort study

AU - Gulliford, Martin Christopher

AU - Ravindrarajah, Rathi Sivagowri

AU - Hamada, Shota

AU - Jackson, Stephen

AU - Charlton, Judith Dawn

PY - 2017/6/27

Y1 - 2017/6/27

N2 - Objective: Statin use over the age of 80 years is weakly evidence-based. This study aimed to estimate rates of statin inception and deprescribing by frailty level in people aged 80 years or older. Methods: A cohort of 212,566 participants aged ≥80 years was sampled from the UK Clinical Practice Research Datalink. Statin inception was defined as a first-ever prescription in a non-statin user; deprescribing was defined as a last ever statin prescription more than 6 months before the end of participant records. Rates were estimated in a time-to-event framework allowing for mortality as a competing risk. Covariates were age, gender, frailty category and prevention type. Results: Prevalent statin use increased from 2001-5 (9.9%) to 2011-15 (49.3%). Inception of statins in never-users was low overall at 2.4% per year (95% confidence interval (CI) 2.2% to 2.6%) and declined with age. Deprescribing of statins in current users occurred at a rate of 5.6% (95% CI 5.4% to 5.9%) per year overall and increased with age, reaching 17.8% per year (95% CI 6.7% to 28.9%) among centenarians. Deprescribing was slightly higher for primary prevention (6.5% per year) than secondary prevention (5.2% per year) indications (P<0.001). Deprescribing increased with frailty level being 5.0% per year in ‘fit’ participants and 7.1% in ‘severe’ frailty (P<0.001). Conclusions: Statin use has increased in the over-80s but deprescribing is common and increases with age and frailty level. These paradoxical findings highlight a need for better evidence to inform statin use and discontinuation for people aged ≥80 years.

AB - Objective: Statin use over the age of 80 years is weakly evidence-based. This study aimed to estimate rates of statin inception and deprescribing by frailty level in people aged 80 years or older. Methods: A cohort of 212,566 participants aged ≥80 years was sampled from the UK Clinical Practice Research Datalink. Statin inception was defined as a first-ever prescription in a non-statin user; deprescribing was defined as a last ever statin prescription more than 6 months before the end of participant records. Rates were estimated in a time-to-event framework allowing for mortality as a competing risk. Covariates were age, gender, frailty category and prevention type. Results: Prevalent statin use increased from 2001-5 (9.9%) to 2011-15 (49.3%). Inception of statins in never-users was low overall at 2.4% per year (95% confidence interval (CI) 2.2% to 2.6%) and declined with age. Deprescribing of statins in current users occurred at a rate of 5.6% (95% CI 5.4% to 5.9%) per year overall and increased with age, reaching 17.8% per year (95% CI 6.7% to 28.9%) among centenarians. Deprescribing was slightly higher for primary prevention (6.5% per year) than secondary prevention (5.2% per year) indications (P<0.001). Deprescribing increased with frailty level being 5.0% per year in ‘fit’ participants and 7.1% in ‘severe’ frailty (P<0.001). Conclusions: Statin use has increased in the over-80s but deprescribing is common and increases with age and frailty level. These paradoxical findings highlight a need for better evidence to inform statin use and discontinuation for people aged ≥80 years.

U2 - 10.1093/ageing/afx100

DO - 10.1093/ageing/afx100

M3 - Article

SN - 0002-0729

VL - 46

SP - 1001

EP - 1005

JO - Age and Ageing

JF - Age and Ageing

IS - 4

ER -