Stopping Statins After 75 Didn’t Raise Deaths in Low-Risk Older Adults, Trial Finds

Older adults taking a statin purely for prevention often wonder whether they still need it. A randomised trial offers reassurance for a specific group — while stopping short of telling anyone to quit.

Published in Lancet Healthy Longevity, the French study enrolled 1,160 patients (average age 80) from general practices who had taken statins for prevention, most for at least five years, and randomly assigned them to continue or stop.

The results

Over three years, deaths were similar: 7.2% in the stop group versus 7.9% in the continue group, with no significant difference in major cardiovascular events and no change in quality of life.

LDL cholesterol did jump about 50% — from 115 to 171 mg/dL — three months after stopping.

Why a deprescribing trial is unusual

Almost all drug trials ask whether starting a treatment helps. Very few ask whether stopping one harms — and the asymmetry has consequences.

Medications accumulate over a lifetime. Each was started for a reason that made sense at the time, and few are ever formally reviewed against whether that reason still applies. Older adults commonly take many drugs, with interaction risk and side-effect burden rising accordingly.

Deprescribing has emerged as a discipline to address that, and it has been hampered by an absence of evidence. Clinicians considering stopping a preventive medication in an 80-year-old have had little to go on beyond judgement, because nobody funds trials of discontinuing off-patent drugs.

Reconciling the LDL rise with the outcome

A 50% LDL increase with no difference in events looks contradictory, and the explanation is time.

Statins work by slowing atherosclerotic plaque development, and that process operates over decades. The cardiovascular benefit of lowering cholesterol accrues gradually — trials in middle-aged populations typically show curves separating after a year or two and widening thereafter.

Three years is short by that standard. A patient stopping at 80 would be expected to accumulate additional plaque, and whether that translates into an event depends on how long they live afterwards.

The trial therefore does not show that LDL does not matter. It shows that over three years in this population, the additional risk was too small to detect — which is a narrower and more useful claim.

The time-to-benefit framing

That reasoning has been formalised in geriatrics as time to benefit: how long a preventive therapy must be taken before it produces measurable benefit, compared against a patient’s remaining life expectancy.

Preventive treatments impose costs immediately — side effects, cost, pill burden, monitoring — and deliver benefits later. For someone with many years ahead the trade is clearly worthwhile; for someone whose life expectancy is shorter than the time to benefit, they receive all the costs and none of the return.

This trial provides empirical support for applying that reasoning to primary-prevention statins in low-risk older adults.

What it does not say

The study explicitly does not recommend routine discontinuation, supporting individualised decisions weighing life expectancy, other conditions and patient preference.

The scope is narrow and every restriction matters. It applies to primary prevention — no prior heart attack or stroke. Patients with established cardiovascular disease are a different population where the evidence for continuing is considerably stronger.

It also applies to low-risk patients. Someone over 75 with diabetes, hypertension, kidney disease or a strong family history is not represented.

The population caveat the authors emphasise

Co-author Fabrice Bonnet stressed the finding “has to be confirmed in other populations,” noting French participants had lower cardiovascular mortality than typical US patients.

That is a substantive limitation rather than routine hedging. If baseline event rates are lower, there are fewer events to prevent, and a treatment effect that would be detectable in a higher-risk population may vanish. The same trial run in a population with more cardiovascular disease could produce a different answer.

How to use it

For healthy, low-risk people over 75 taking statins only to prevent a first event, the findings suggest they “may be no worse off” stopping over this timeframe.

The wider deprescribing question this opens

Statins are one instance of a problem that applies across preventive medicine in older adults, and the trial matters partly as a template.

Many long-term medications are started in middle age on evidence generated in middle-aged populations, then continued indefinitely without the original reasoning being revisited. Blood pressure targets, bone protection, aspirin, proton pump inhibitors and diabetes intensity all raise similar questions once a patient reaches their eighties with limited life expectancy and competing conditions.

In each case the evidence for starting is reasonable and the evidence for continuing at advanced age is thin, because the trials were not done in that population and nobody has funded the discontinuation studies.

The practical consequence is inertia. Stopping a medication requires an active decision and carries perceived risk if something subsequently goes wrong, while continuing requires nothing and attracts no scrutiny. That asymmetry keeps people on drugs long after the balance has shifted — and trials like this one are the only thing that shifts it, which is why the absence of commercial incentive to run them is a genuine gap in the evidence base.

It is one trial, not a green light. What it changes is the nature of the conversation: a clinician and patient discussing whether to continue now have data rather than only judgement, which is a meaningful improvement even when the answer remains individual. This summarises one study and is not medical advice. Do not start or stop any medication without talking to your doctor.