Stopping statins ‘early’ may slash protection against heart disease, study says

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Stopping statins 'early' may slash protection against heart disease, study says

Adults at high cardiovascular risk start to accrue benefit early on from taking statins and have more to lose by delaying therapy than those at low risk, a new study says. Photo by Tasique/Shutterstock

Stopping prescribed statin medication “early” — or even at age 80, instead of using it for a lifetime — may substantially reduce protection against heart disease, a British study released Thursday warns.

The British research follows on the heels of an expert U.S. panel again urging adults ages 40 to 75 at high risk for a first heart attack or stroke to take cholesterol-lowering statins.

Its findings will be presented Saturday at the European Society of Cardiology’s Congress 2022 in Barcelona, Spain.

“Stopping treatment, unless advised by a doctor, does not appear to be a wise choice,” Dr. Runguo Wu, the new study’s lead researcher and a health economist at Queen Mary University of London, in the United Kingdom, said in a press release.

Researchers said some uncertainty exists over when to start and how long to continue statin treatment to optimize its effects.

Using a “microsimulation model” based on 600,000-plus people, they estimated the accumulation of benefit from statin use over time.

Specifically, they looked at the effect of a standard 40-milligram daily dose of statins, versus no therapy, under three scenarios: lifelong treatment; therapy discontinued at age 80, and delayed initiation of statins by five years in participants under age 45.

They found a large part of quality-adjusted life years, or QALY, meaning years of life in perfect health, that were gained by using statins occurred later in life.

Compared with lifelong statin therapy, for example, stopping statins at age 80, “erased a large share of the potential benefit, especially for people with relatively low cardiovascular risk,” the study said.

“Our study suggests that people who start taking statins in their 50s, but stop at 80 years of age instead of continuing lifelong, will lose 73% of the QALY benefit if they are at relatively low cardiovascular risk and 36% if they are at high cardiovascular risk — since those at elevated risk start to benefit earlier,” Wu said in the release.

For people under age 45 at low cardiovascular risk, or with less than a 5% likelihood of heart attack or stroke in the next 10 years, a five-year delay in taking statins had little impact: They lost 2% of the potential QALY benefit from lifelong therapy.

But those in the same age group who are at high cardiovascular risk, with more than a 20% likelihood of heart attack or stroke over the next decade, lost 7% of the potential QALY benefit from lifelong therapy.

“Again, this is because people at higher cardiovascular risk start to accrue benefit early on and have more to lose by delaying statin therapy than those at low risk,” Wu said.

Other experts are worried about the continued focus on statins.

They contend it’s time — now that the U.S. Preventive Services Task Force has released its new guideline reiterating its 2016 one — to curb the medical community’s enthusiasm for the drug.

“In the U.S., about $25 billion is spent annually on statins,” said Dr. Anand R. Habib, lead author in an editorial published in JAMA Internal Medicine that accompanied the national task force’s new statement.

Habib is a clinical instructor of medicine in the Division of Hospital Medicine at the University of California-San Francisco.

Although statins lower low-density lipoproteins, or “bad” LDL cholesterol, some of this massive spending might be shifted to needed investments at the community level, Habib and his co-authors said.

Such a spending shift would create a better environment “that enables healthy eating and promotes physical activity are likely to have more widespread … effects on the biological and psychosocial risks of [cardiovascular disease], as well as on improving quality of life,” they said.

Habib said the task force’s 2022 recommendations on statin use “are an opportunity to pause and refocus efforts to meaningfully improve [cardiovascular disease] outcomes for all, rather than extol the marginal, likely small, and uncertain absolute benefits of statins for the few” in primary cardiovascular disease prevention.

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