Key result
Statin discontinuation after age 75 linked to ~28% higher MACE risk in primary prevention.
Why the study?
Randomised evidence for statins in primary prevention beyond age 75 is limited, making statin discontinuation at age 75 common practice despite limited outcome data on whether it increases MACE risk.
Does discontinuation of statin therapy increase the risk of major adverse cardiovascular events (MACE) compared with continued statin therapy in adults aged >=75 years receiving statins for primary prevention?
Cohort (n=71,439)
Does discontinuation of statin therapy increase the risk of major adverse cardiovascular events (MACE) compared with continued statin therapy in adults aged >=75 years receiving statins for primary prevention?
In adults aged 75 and older on statins for primary prevention, discontinuing statin therapy is associated with a 28% higher risk of major adverse cardiovascular events, supporting careful reassessment before routine deprescribing.
Answers are grounded in this paper and cite their sources.
Statin discontinuation was associated with higher MACE; extends observational support for continuation in primary prevention but leaves causality open.
Background Statins reduce cardiovascular events in primary prevention before age 75. Beyond this age, randomised evidence is limited, and guideline recommendations emphasise individualised decision-making. As a result, statin discontinuation at age 75 has become common practice despite limited outcome data. We hypothesized that discontinuation of statin therapy may increase the risk of major adverse cardiovascular events (MACE) in this population. Purpose To determine whether discontinuation of statin therapy in this population is independently associated with an increased risk of MACE compared with continued statin therapy. Methods We conducted a retrospective cohort study using longitudinal electronic health record data from Clalit Health Services, covering approximately two-thirds of the Israeli elderly population. Adults aged ≥75 years without established atherosclerotic cardiovascular disease and receiving statins for primary prevention were included. Patients were classified as continuation (reference) or discontinuation. The primary endpoint was MACE (acute myocardial infarction, ischaemic stroke, all-cause death). Secondary outcomes included each outcome separately. Inverse probability of treatment weighting using propensity scores, balanced baseline characteristics: demographics, comorbidities, lipids, blood pressure, body mass index, smoking status, and additional cardiovascular risk factors. Weighted Cox proportional hazards models estimated adjusted hazard ratios (HR) with 95% confidence intervals (CI). Results Among 71,439 eligible patients, 67,188 continued and 4,251 discontinued therapy. Incidence rates of MACE were 46 and 61 per 1,000 person-years in the continuation and discontinuation groups, respectively. Discontinuation was associated with an increased risk of MACE (adjusted HR 1.28; 95% CI 1.21–1.36; P<0.001). Associations were consistent across individual components (Figure 1). Conclusions In older adults receiving statins for primary prevention, discontinuation after age 75 was associated with higher cardiovascular risk. These findings support careful reassessment before routine deprescribing in this population.
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Arbel et al. (2026) conducted a cohort in Primary prevention of cardiovascular disease in adults aged ≥75 years (n=71,439). Statin discontinuation vs. Statin continuation (reference) was evaluated on Major adverse cardiovascular events (MACE: acute myocardial infarction, ischaemic stroke, all-cause death) (adjusted HR 1.28, 95% CI 1.21-1.36, p=<0.001). Statin discontinuation after age 75 in primary prevention was associated with an increased risk of MACE vs continuation (adjusted HR 1.28; 95% CI 1.21-1.36; P<0.001).
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