Statins in Older Danes: Factors Associated With Discontinuation Over the First 4 Years of Use.
BACKGROUND AND OBJECTIVE
Use of statins is considerable among older persons. We investigated factors associated with statin discontinuation in new statin users aged 70 years or older within the first 4 years of use.


DESIGN
Register-based descriptive drug utilization study using data from 2008 to 2016.


POPULATION/SETTING
All Danish persons, aged 70 years or older, initiating statin treatment.


MEASUREMENTS
Rates and predictors of statin discontinuation after 1 year (early), 2 years, and 4 years. Predictors of discontinuation were estimated using logistic regression.


RESULTS
We included 83 788 statin initiators. At 1 year, 13% had discontinued their treatment, while another 12% and 13% discontinued after 2 and 4 years, respectively. The overall discontinuation rate over 4 years was 32%. Increasing age was associated with discontinuation at all time points (adjusted odds ratio [OR] = 2.06 [95% confidence interval {CI} = 1.35-3.16] at 1 year, adjusted OR = 3.94 [95% CI, 1.83-8.49] at 4 years, comparing those aged >95 years to those aged 70-74 years). Further, higher comorbidity scores and use of more than 10 medications were modestly associated with discontinuation. Use of statins for secondary prevention was associated with decreased odds of discontinuation compared to primary prevention at 1 year (adjusted OR = 0.74; 95% CI, 0.65-0.83) and at 4 years (adjusted OR = 0.83; 95% CI, 0.72-0.95), along with concomitant use of cardiovascular (CV) therapies. The annual proportion of early discontinuers ranged from 14% to 17% for primary prevention and from 9% to 12% for secondary prevention between 2008 and 2015.


DISCUSSION
Statin discontinuation within the first 4 years after initiation appeared to be influenced most strongly by age, and may also be influenced by comorbidity, polypharmacy, use for secondary prevention, and concomitant CV medication use. Future research should clarify reasons for, and discussions about, statin discontinuation and initiation among older persons, to provide additional insight on this topic. J Am Geriatr Soc 67:2050-2057, 2019.
['Thompson|Wade|W|', 'Jarbøl|Dorte Ejg|DE|', 'Haastrup|Peter|P|', 'Nielsen|Jesper Bo|JB|', 'Pottegård|Anton|A|']
D000367:Age Factors D000368:Aged D000369:Aged, 80 and over D015897:Comorbidity D003718:Denmark D004243:Divorce D004522:Educational Status D005260:Female D006801:Humans D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors D016015:Logistic Models D008297:Male D055118:Medication Adherence D019338:Polypharmacy D011322:Primary Prevention D012042:Registries D055502:Secondary Prevention
statins polypharmacy medication discontinuation