This is often one of the most challenging questions in geriatrics: When should we discontinue statins in the elderly? I’ve been asked this question several times, and there are a lot of factors that go into my assessment as to whether a statin should be discontinued or not.

First off, there is not much literature out there for this age population (>80-85 years old).  Not having a lot of clinical literature to evaluate and make decisions more black and white is a problem.

I can share with you some of the questions that I think about when trying to minimize polypharmacy, but also making sure that we are putting patients at serious risk of cardiovascular issues.

1. Patient and/or family beliefs.  This should be an important consideration and will help you decide whether you should DC a statin or not.
2. Do we have a short life expectancy in our patient? The shorter the life expectancy, the more likely you are going to discontinue a statin.  Hospice patients are a classic example where you will likely try to minimize the medication burden and discontinue a statin.
3. What’s the cardiovascular risk?  Has the patient had multiple heart attacks? Diabetes, etc.? The higher the risk of an event if the patient stops a statin, the less likely we will want to discontinue it.
4. If you discontinue a statin and the patient has a heart attack, would you restart it?  If you would, this might be a case where you would not want to discontinue it in the first place.
5. Are there possible complications from the statin? Drug interactions, possible myopathy etc. – This would help you lean towards discontinuing it.
6. What’s the labwork say? Is this a patient with a wicked high LDL?  Another reason to possibly keep a patient on a statin.
7. Along with life expectancy goes the quality of life.  Does the patient have advanced dementia or another condition that doesn’t allow them to live life as they would want? Another great situation to get the family involved and have their input.

What did I miss? Do you have any other tips as to when statins should be discontinued in the elderly? If you are looking for the basics on statins, be sure to check out the podcast!

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