Cases in Deprescribing: When to Get Rid of the Statin

Charles P. Vega, MD

Disclosures

January 31, 2019

Door Number...

I will take C, which may seem like an easy way out. But wait—I have my reasons!

Statins may not be effective in improving rates of cardiovascular disease and mortality among older adults. In a trial that included nearly 1500 adults over 65 years of age with no history of cardiovascular events, pravastatin 40 mg failed to improve risk for cardiovascular disease or overall mortality over 6 years of follow-up when compared with placebo.[1] Analyses from other trials of statins and retrospective studies also find modest or no improvement in the risk for cardiovascular disease, and no effect on mortality.[2,3]

However, patients under the age of 85 years with diabetes may still experience not only an improvement in the risk for cardiovascular disease with statins, but a reduction in risk for all-cause mortality as well.[2] Moreover, I am missing a major part of this patient's cardiovascular profile because I have no lipid profile on record.

If he is tolerating atorvastatin well, and most patients do, then I would check the lipid panel and favor continuing the statin if the results do not demonstrate a low level of LDL cholesterol.

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