New findings from a federally funded randomised study indicate that it is safe to stop statin therapy in patients with a life expectancy of less than a year.

Discontinuing statins did not shorten survival, and provided a number of important benefits, including reduced pill and symptom burden and improved overall quality of life.

“Many doctors argue that, near the end of life, it is not necessary to continue medications for chronic illnesses that are not life-threatening. But we have no guidance on what medicines to stop and when to do so,” said lead study author Amy P. Abernethy, MD, PhD, a medical oncologist and palliative care specialist at Duke University Medical Center in Durham, NC.

“Our study provides the first evidence that stopping statins is safe and improves patient quality of life.”

The number of medications patients take doubles in the last year of life for those with terminal illnesses.

This means patients are taking 10 or more different pills per day – a big burden for patients who frequently have difficulty swallowing and poor appetite.

An additional problem is that the side effects of each medication accumulate, and new side effects can appear when multiple drugs are taken together.

Furthermore, interactions between drugs can reduce the efficacy of individual treatments.

This study included 381 patients with life-limiting illness (49 percent had cancer) and a life expectancy of one month to one year, who had been taking a statin for at least three months.

Statins are cholesterol-lowering drugs prescribed to reduce the risk of heart attacks and strokes.

The most common side effects of statins are headache, difficulty sleeping, muscle aches, drowsiness, and dizziness.

Patients were randomly assigned to either continue or discontinue statin therapy.

Researchers found that discontinuing statins was safe.

Few patients in either group experienced cardiovascular complications (13 in the group that discontinued vs. 11 in the group that continued).

The rate of death within 60 days was not significantly different between the two groups (20.3 percent vs. 23.8 percent), and the group that discontinued statins even had a longer median time-to-death (229 days vs. 190 days).

Patients who discontinued statins had a substantially better total quality of life (about a 10 percent improvement on a standard scale) and tended to have fewer symptoms.

They also took fewer medications overall compared to patients who continued statins (10.1 vs. 10.8). 

Researchers estimate $603 million would potentially be saved in the United States if all people with a life expectancy of a year or less, similar to the group involved in this study, were to discontinue statins.

However, Dr. Abernethy noted, discontinuing statins is not appropriate for every patient, and the decision should be made on an individual patient basis.

Source: ASCO