Patterns and determinants of statin prescribing and discontinuation in individuals aged 80 and older: A 10-year population-based cohort study

Abstract

Background

Considering the limited knowledge regarding the benefits and risks of statins in people ≥80 years, population use patterns can provide valuable insights.

Objective

To describe prescribing and discontinuation patterns for statins, along with their determinants, in people ≥80 years in Québec, Canada.

Methods

Using the Quebec Integrated Chronic Disease Surveillance System, we built a population-based cohort of community-dwelling adults aged ≥80 years on January 4, 2018. We assessed statin use in the 5 years before and after cohort entry to calculate the proportion of prevalent, incident, and discontinued statin users. We used multivariable Cox models to identify factors associated with initiation and discontinuation, using hazard ratios (HRs) and 95% confidence intervals.

Results

A total of 317,027 individuals of mean age 85.2 years were included. At cohort entry, 51% were prevalent statin users. Within 5 years, 11% of nonusers initiated a statin. Among prevalent users, 22% discontinued their therapy during follow-up. Strongest factors associated with initiation included ages 80–84 (HRs ranging from 0.74 [95% confidence interval: 0.71–0.76] for 85–89 years to 0.26 [0.22–0.30] for 95+), previous statin use (1.99 [1.93–2.07]), and male sex (1.44 [1.39–1.49]). Older age (HRs ranging from 1.54 [1.51–1.58] for 85–89 years to 3.65 [3.42–3.89] for 95+), and Alzheimer's disease (1.77 [1.71–1.82]) were the most common factors for discontinuation. Previous cardiovascular disease was associated with both initiation (1.26 [1.07–1.49]) and reduced likelihood of discontinuation (0.69 [0.64–0.74]).

Conclusion

Statin use remains prevalent among the ≥80 years. A thorough evaluation of the risk/benefit balance of such use is needed.