Frailty and statins | Right Decisions

There is limited evidence on whether statins prescribed for primary or secondary prevention were associated with reduced Major Adverse Cardiovascular Events (MACE) among adults older than 65 years living with frailty.

Based on one systematic review (SR) judged to be acceptable in quality and of partial relevance,¹⁰² it is not possible to determine:

If a statin prescribed for the purpose of primary or secondary prevention reduces the risk of mortality/MACE among older adults with frailty.
If statin prescribing will change the frequency of admission to long-term care or reduce frequency of admission to hospital.
What impact statins have on the treatment burden or quality of life of people with frailty.

Nevertheless, some evidence within the same SR is less unequivocal, and so the following should be noted:

That people more often stop statins when prescribed for the purpose of primary prevention than for secondary prevention.
That the likelihood of deprescribing a statin increases with severity of frailty.

The list below sets out the recommendations on reviewing the evidence, and a considered judgment process.

Recommendations when managing frailty and statins

1 - Good practice point

Prescribers and older people with frailty may want to discuss reducing or stopping a statin because the evidence does not indicate:

Reduction in morbidity/mortality in primary prevention

A change in the frequency of admission to long-term care, or reduced frequency of admission to hospital

2 - Good practice point

Prescribers and older people with frailty may wish to discuss what effect taking a statin has on treatment burden, or quality of life. Within the polypharmacy manage medicines app, prescribers and patients may wish to use shared decision-making tools, such as NNT charts or Cates plots to help visualise potential magnitude of benefit of medication for this intervention.