Discontinuation versus continuation of statins: A systematic review.

Autor: Peixoto C; Institut du Savoir Montfort, Ottawa, Ontario, Canada., Choudhri Y; Queen's University, Kingston, Ontario, Canada., Francoeur S; Institut du Savoir Montfort, Ottawa, Ontario, Canada., McCarthy LM; Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada.; Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada.; Women's College Research Institute, Toronto, Ontario, Canada.; Bruyère Research Institute, Ottawa, Ontario, Canada., Fung C; Department of Family Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada., Dowlatshahi D; Department of Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada., Lemay G; Institut du Savoir Montfort, Ottawa, Ontario, Canada.; Department of Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada., Barry A; Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada., Goyal P; Program for the Care and Study of the Aging Heart, Department of Medicine, Weill Cornell Medicine, New York, New York, USA., Pan J; Department of Anesthesiology, Pharmacology, and Therapeutics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada., Bjerre LM; Institut du Savoir Montfort, Ottawa, Ontario, Canada.; Department of Family Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada., Thompson W; Department of Anesthesiology, Pharmacology, and Therapeutics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
Jazyk: angličtina
Zdroj: Journal of the American Geriatrics Society [J Am Geriatr Soc] 2024 Nov; Vol. 72 (11), pp. 3567-3587. Date of Electronic Publication: 2024 Jul 25.
DOI: 10.1111/jgs.19093
Abstrakt: Background: Clinicians and patients often face a decision to continue or discontinue statins. We examined the impact of discontinuation of statins compared with continuation on clinical outcomes (all-cause mortality, cardiovascular [CV] mortality, CV events, and quality of life).
Methods: We conducted a systematic review. Randomized controlled trials (RCTs), cohort studies, case-control studies, and quasi-randomized studies among people ≥18 years were eligible. We searched MEDLINE, Embase, and Cochrane Central Registry (inception to August 2023). Two independent reviewers performed screening and extracted data. Quality assessment was performed by one author and verified by another. We summarized results narratively, performed meta-analysis for a subset of studies, and used GRADE to assess certainty of evidence. We summarized findings in the subgroup of persons ≥75 years.
Results: We retrieved 8369 titles/abstracts; 37 reports from 36 studies were eligible. This comprised 35 non-randomized studies (n = 1,708,684) and 1 RCT (n = 381). The 1 RCT was conducted among persons with life expectancy <1 year and showed there is probably no difference in 60-day mortality (risk difference = 3.5%, 90% CI -3.5 to 10.5) for statin discontinuation compared with continuation. Non-randomized studies varied in terms of population and setting, but consistently suggested that statin discontinuation might be associated with a relative increased risk of mortality (hazard ratio (HR) 1.92, 95% CI 1.52 to 2.44, nine studies), CV mortality (HR 1.63, 95% CI 1.27 to 2.10, five reports), and CV events (HR 1.31, 95% CI 1.23 to 1.39, eight reports). Findings in people ≥75 years were consistent with main results. There was a high degree of uncertainty in findings from non-randomized studies due to methodological limitations.
Conclusions: Statin discontinuation does not appear to affect short-term mortality near end-of-life based on one RCT. Outside of this population, findings from non-randomized studies consistently suggested statin discontinuation may be associated with worse outcomes, though this is uncertain.
(© 2024 The Author(s). Journal of the American Geriatrics Society published by Wiley Periodicals LLC on behalf of The American Geriatrics Society.)
Databáze: MEDLINE
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