Evidence-Based Deprescribing of Statins in Patients With Advanced Illness

Several observational studies have demonstrated that statins continue to be prescribed for patients with limited life expectancy. In one study, 2 up to 62% of patients with cancer and a poor prognosis continued to receive statins, often for primary prevention of cardiovascular disease. In another trial, 3 the time to stopping treatment with a statin was similar in patients with cancer and in those without cancer, and more than 31% of patients with cancer filled a statin prescription within 30 days of death. Patients with other life-limiting illness, such as advanced dementia, also continued to receive statins even at the end of life. 4 Why are statins continued until the end of life? This is a complex multifaceted issue. Stopping statin therapy in the case of limited life expectancy has been advocated as a relatively straightforward decision; a recommendation of the Choosing Wisely campaign advises not to start lipid-lowering medications in patients with limited life expectancy. 5 However, at present, little is known about the barriers faced by clinicians when stopping statin treatment in patients with limited life expectancy. There may be continued uncertainty on the part of clinicians about the benefits afforded by continuing the treatment, particularly if a patient has been receiving the medication for a long time without adverse effects. Furthermore, clinicians and patients may be uncertain about the benefits and harms of discontinuing the therapy. In this issue of JAMA Internal Medicine, Kutner and colleagues 1 present the results of its first multicenter study: a pragmatic randomized trial of statin therapy discontinuation in patients with advanced disease and limited prognosis. This study suggests that stopping statin treatment at the end of life may be safe and is potentially associated with improved quality of life and reduced cost. The importance of these results cannot be overstated; clinicians wishing to recommend discontinuing the treatment in patients with advanced disease and limited life expectancy now have an evidence base to inform their decision making. Indeed, patients and their caregivers can now be advised that both withdrawing and continuing statin therapy are reasonable alternatives in advanced illness and in the absence of recent cardiovascular events. Will this study provide the evidence needed to help clinicians deprescribe statin treatment? Kutner et al 1 suggest that