Institut du Savoir Montfort, Ottawa, Ontario, Canada.
Queen's University, Kingston, Ontario, Canada.
J Am Geriatr Soc. 2024 Nov;72(11):3567-3587. doi: 10.1111/jgs.19093. Epub 2024 Jul 25.
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).
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.
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.
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.
临床医生和患者经常面临继续或停止使用他汀类药物的决策。我们研究了与继续使用相比，停止使用他汀类药物对临床结果（全因死亡率、心血管死亡率、心血管事件和生活质量）的影响。
我们进行了系统评价。符合条件的研究包括 18 岁及以上人群的随机对照试验（RCT）、队列研究、病例对照研究和准随机研究。我们检索了 MEDLINE、Embase 和 Cochrane 中央注册中心（从成立到 2023 年 8 月）。两名独立审查员进行了筛选并提取了数据。由一名作者进行质量评估，另一名作者进行验证。我们以叙述方式总结结果，对部分研究进行了荟萃分析，并使用 GRADE 评估证据的确定性。我们总结了年龄≥75 岁人群亚组的发现。
我们检索到 8369 篇标题/摘要；36 项研究的 37 项报告符合条件。这包括 35 项非随机研究（n=1708684）和 1 项 RCT（n=381）。这项 RCT 是在预期寿命<1 年的人群中进行的，结果表明，与继续使用相比，他汀类药物停药后 60 天内死亡率可能没有差异（风险差异=3.5%，90%CI-3.5 至 10.5）。非随机研究在人群和研究环境方面存在差异，但一致表明，他汀类药物停药可能与死亡率相对增加相关（风险比（HR）1.92，95%CI 1.52 至 2.44，9 项研究）、心血管死亡率（HR 1.63，95%CI 1.27 至 2.10，5 项报告）和心血管事件（HR 1.31，95%CI 1.23 至 1.39，8 项报告）。年龄≥75 岁人群的结果与主要结果一致。由于方法学上的限制，非随机研究的结果存在高度不确定性。
根据一项 RCT，他汀类药物停药似乎不会影响临终前的短期死亡率。在该人群之外，非随机研究的结果一致表明，他汀类药物停药可能与更差的结果相关，但这是不确定的。
