Statins in Older Danes: Factors Associated With Discontinuation Over the First 4 Years of Use

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Resumé

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.

OriginalsprogEngelsk
TidsskriftJournal of the American Geriatrics Society
Vol/bind67
Udgave nummer10
Sider (fra-til)2050-2057
ISSN0002-8614
DOI
StatusUdgivet - okt. 2019

Fingeraftryk

Hydroxymethylglutaryl-CoA Reductase Inhibitors
Odds Ratio
Confidence Intervals
Primary Prevention
Comorbidity
Drug Utilization
Logistic Models

Bibliografisk note

© 2019 The American Geriatrics Society.

Citer dette

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title = "Statins in Older Danes: Factors Associated With Discontinuation Over the First 4 Years of Use",
abstract = "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.",
keywords = "medication discontinuation, polypharmacy, statins",
author = "Wade Thompson and Jarb{\o}l, {Dorte Ejg} and Peter Haastrup and Nielsen, {Jesper Bo} and Anton Potteg{\aa}rd",
note = "{\circledC} 2019 The American Geriatrics Society.",
year = "2019",
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language = "English",
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pages = "2050--2057",
journal = "Journal of the American Geriatrics Society",
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TY - JOUR

T1 - Statins in Older Danes

T2 - Factors Associated With Discontinuation Over the First 4 Years of Use

AU - Thompson, Wade

AU - Jarbøl, Dorte Ejg

AU - Haastrup, Peter

AU - Nielsen, Jesper Bo

AU - Pottegård, Anton

N1 - © 2019 The American Geriatrics Society.

PY - 2019/10

Y1 - 2019/10

N2 - 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.

AB - 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.

KW - medication discontinuation

KW - polypharmacy

KW - statins

U2 - 10.1111/jgs.16073

DO - 10.1111/jgs.16073

M3 - Journal article

C2 - 31335968

VL - 67

SP - 2050

EP - 2057

JO - Journal of the American Geriatrics Society

JF - Journal of the American Geriatrics Society

SN - 0002-8614

IS - 10

ER -