Statins, Aging, Multiple Meds (polypharmacy) and Stopping Meds (deprescribing)
As we age we are more vulnerable to medication side effects and interactions. We are also at higher risk for complications from dangerous chronic diseases. Every medical decision in this area involves a careful analysis of risk vs benefits. Age is the most powerful risk factor for serious cardiovascular events like heart attack and stroke. The higher the risk for cardiovascular events, the greater the benefit of optimal medical treatment. Stopping statins in older patients because of concerns about taking too many medications results in increased hospitalizations for heart failure, ER visits, cardiovascular events, and death from any cause. The risk of stopping statins in this setting is clearly greater than the risk of continuing them.
Older individuals have multiple health problems that impair the quality of life. Almost unavoidably, multiple health problems lead to taking many medications. However, having multiple chronic diseases and taking multiple medications may have negative effects. The cure can be worse than the disease and further reduce quality of life by causing confusion and other mental impairments. Multiple medications increase the effect of drug interactions. Because of these problems there has been an increasing focus on gradually reducing or stopping drugs, to minimize drug side effects and interaction to improve patients’ health outcomes. This attitude is so widespread that there is a special term for it. It is called deprescribing. However, according to several randomized clinical trials, while reducing the number of drugs appears to reduce inappropriate medicine use, its effect treatment results such as hospital admissions and death remained uncertain. Reducing medications in older adults needs much more research and it must be done very carefully. Statins and other components of optimal medical treatment for cardiovascular and related conditions should be continued.
Statins have an impact beyond reducing LDL cholesterol production. Statins reduce oxidative particle formation (ROS, oxidative stress). They reduce inflammation, scar formation, proliferation of damaging cells and death of cells in the heart and arteries that are critical to organ function. Statins activate the master metabolic switch AMPK. As expected, they also inhibit mTOR. These effects are independent of statin-related LDL cholesterol reduction. Calorie restricted diet, intermittent fasting, exercise, ACE inhibitors like lisinopril, ARBs like losartan, MRA inhibitors like spironolactone, and biguanides like metformin all directly or indirectly switch off the genetic master metabolic switch mTOR and switch on AMPK. In combination, these medications and lifestyle interventions represent optimal medical treatment and statins are a critical component. They dramatically reduce the number of heart attacks and strokes. They prolong healthy life. They reduce death from all causes. They should be continued with the appropriate precautions, especially in high-risk patients like the aged. AMPK and mTOR regulate aging itself. Switching off mTOR and switching on AMPK extends healthy life in several species. This same effect has been proven in humans. Optimal medical treatment blocks signaling from genes that are switched off or much less active in healthy young people but are inappropriately switched on in chronic disease and aging itself. It can be safely continued with the proper precautions.
If you think about statins as cholesterol lowering drugs, dropping them in elderly people can make sense. LDL cholesterol takes time to increase the danger. If you understand them as antioxidants, plaque stabilizers, anti-inflammatory, and organ protective, it makes more sense to continue them. It is time to stop thinking about these medications as tools to control risk factors. New science helps us understand they protect all cells and organs to prolong healthy life. Once again, evidence is critical to improving health and reducing costs.