3690 Efficacy and safety of statin discontinuation in older people living with frailty: a UK population-wide study

Abstract Introduction In older patients, and in those living with frailty, the evidence for continued statin description is uncertain. Current guidelines advocate for an individualised approach, including consideration of deprescribing where the benefits are unclear. Aim Determine safety and efficacy of statin discontinuation in older people, stratified by frailty status. Methods This was a retrospective cohort study using data from Clinical practice research Datalink (CPRD) between 1998–2021. Inclusion criteria were age ≥ 65 years, with a 12-month statin medication possession ratio of ≥80%. Statin discontinuation was defined as no prescription for ≥180 days. Exposed participants were matched within practice 1:2 to those unexposed. The primary outcome measure was all-cause hospitalisation; secondary outcomes included major adverse cardiovascular events (MACE), muscle disorders, liver injury, new diabetes mellitus or cataracts. The effect of discontinuation was examined using Fine-Grey models accounting for competing risk of death, with inverse probability of treatment weighting to adjust for confounding. Results were stratified by electronic Frailty Index (eFI) category, dementia, care home residency, or housebound status in preceding year. Results The cohort included 65,727 participants who stopped a statin, and 131,453 who continued. The 1-year sub Hazard Ratios (sHR) for hospitalisation and MACE, with statin discontinuation, were 1.22 (95% CI 1.20–1.25) and 1.3 (95%CI 1.24–1.35) respectively. However, for those living with severe frailty (eFI ≥ 0.36), dementia, housebound or in a care home, risks of all-cause hospitalisation, stroke, myocardial infarction and heart failure, at 1 and 5 years, were either non-significant, or lower. Discontinuation was linked to lower risks of some statin-related adverse events (e.g. 5-Year sHR for new diabetes 0.79 [95%CI 0.74–0.84]). Conclusions Statin discontinuation is associated with an increased risk of hospitalisation and cardiovascular disease, but in those living with frailty, the relative risks of hospitalisation were lower. This may be important informing patient-centred decisions for this population.