Stopping statins after 65 linked to more hospital stays, but less so with severe frailty

What the study did

Researchers at the University of Oxford used anonymized primary care records from the Clinical Practice Research Datalink in England, linked to hospital and death records, covering 1998 to 2021. They identified 383,342 people aged 65 or older who had taken a statin consistently for at least a year. Of these, 65,727 stopped (no new prescription for 180 days) and were matched within their practice to 131,453 people who kept taking a statin. The average age was 75.9 years, half were women, and follow-up averaged 4.1 years.

The main outcome was any hospital admission lasting at least 24 hours, measured at one and five years. The team grouped people by the electronic frailty index (fit, mild, moderate or severe frailty) and also looked separately at dementia, care home residents and people who were housebound.

What it found

Across the whole group, stopping a statin was linked to a 22% higher relative risk of hospitalization at one year (subdistribution hazard ratio 1.22, 95% CI 1.20 to 1.25), about 37.6 extra admissions per 1,000 people. At five years the link remained (sHR 1.11).

The pattern changed with frailty. At one year the hazard ratio was 1.30 in fit people, 1.22 with mild frailty and 1.16 with moderate frailty. There was no clear link in people with severe frailty (sHR 1.03, CI 0.94 to 1.12) or dementia (sHR 1.05), and care home residents who stopped actually had fewer admissions (sHR 0.76).

What it does not prove

This was not a randomized trial. People stop statins for many reasons, including side effects, a new diagnosis or a doctor judging that life expectancy is limited, and those reasons can affect hospital risk on their own. The authors note that residual confounding can hinder causal interpretation. The outcome was all hospital admissions, not heart attacks or strokes specifically, and the data come from one country's health system.

The Youthful take

For healthy, active older adults, this adds to the case that statins should not be dropped simply because of age. For people living with severe frailty, dementia or in care homes, the picture looks different, which supports individualized conversations about which medicines still serve a person's goals. Frailty is something we can measure, and this study is a reminder that it belongs in prescribing decisions. Any change to a medicine should be made with your own clinician.