RT Journal Article
SR Electronic
T1 Discontinuation versus continuation of statins: a systematic review
JF The Annals of Family Medicine
JO Ann Fam Med
FD American Academy of Family Physicians
SP 6268
DO 10.1370/afm.22.s1.6268
VO 22
IS Supplement 1
A1 Bjerre, Lise
A1 McCarthy, Lisa
A1 Thompson, Wade
A1 Lemay, Geneviève
A1 Fung, Celeste
A1 Choudhri, Yasmeen
A1 Barry, Arden
A1 Pan, Jeffrey
A1 Goyal, Parag
A1 Peixoto, Cayden
YR 2024
UL http://www.annfammed.org/content/22/Supplement_1/6268.abstract
AB Context: Clinicians and patients often face a decision to continue or discontinue statins to maximize benefit and minimize the risk of harm.Objective: To examine the impact of discontinuation of statins compared to continuation on clinical outcomes.Study Design and Analysis: Systematic review. We conducted a GRADE assessment rating certainty of evidence; results were summarized narratively.Dataset: Randomized controlled trials (RCTs), cohort studies, case-control studies, and quasi-randomized studies were eligible. We searched MEDLINE, Embase, Cochrane Central Registry of Trials (inception to August 2023). Two independent reviewers screened titles/abstracts, full-text articles, and extracted data. Quality assessment (RoB 2.0 for RCTs and ROBINS-I for non-randomized studies) was performed by one author and verified by another.Population Studied: Adults ≥18 yearsIntervention/Instrument: Discontinuation of statin medicationsOutcome Measures: All-cause mortality, cardiovascular (CV) mortality, and CV events (e.g., stroke and MI).Results: We retrieved 8,369 titles/abstracts; 37 reports from 36 studies were eligible. This comprised 35 non-randomized studies (n=1,708,684) and one RCT (n=381). The one RCT was conducted among persons with life expectancy <1 year, and showed that there is probably no difference in 60-day mortality (risk difference=3.5%, 90% CI -3.5 – 10.5) or 1-year risk of CV events (RD=1.2%, P=0.64) for statin discontinuation compared to continuation. Non-randomized studies varied in terms of study population, duration of follow-up, and setting, and consistently suggested that statin discontinuation might be associated with a relative increased risk of all-cause mortality (22 out of 23 studies measuring this outcome), CV mortality (9 out of 9 reports), and CV events (12 out of 12 reports), but there was a high degree of uncertainty for these outcomes due to methodological limitations.Conclusions: Statin discontinuation does not appear to affect short-term mortality or CV risk near end-of-life. Outside of this population, there remains uncertainty about the effects of statin discontinuation despite 35 non-randomized studies. Further non-randomized studies are unlikely to resolve uncertainty. Our findings underscore the need for RCT evidence in appropriately selected individuals, to guide clinical decision-making. Until such RCT data are available, this review provides an overview of evidence for clinicians, researchers, and policymakers.