Statin prescribing patterns in a cohort of cancer patients with poor prognosis

Abstract

Background: There are no evidence-based recommendations for statin continuation or discontinuation near the end of life. However, some expert opinion recommends continuing statins prescribed for secondary versus primary prevention of cardiovascular disease.

Objectives: Our aim was to explore statin prescribing patterns in a longitudinal cohort of individuals with life-limiting illness, and to evaluate differences in these patterns based on secondary versus primary prevention of cardiovascular disease.

Design and setting: This study was a retrospective cohort analysis of 539 persons in an integrated, not-for-profit health maintenance organization (HMO) setting who were receiving statins at diagnosis of a cancer with 0% to 25% predicted 5-year survival. Of the cohort patients, 343 were taking statins for secondary prevention and 196 for primary prevention of cardiovascular disease. Measurements included number and timing of statin refills between diagnosis and date of death, disenrollment, or the end of the observation period.

Results: Four hundred and ninety-six cohort members died within the observation period. Fifty-eight percent of the secondary prevention and 62% of the primary prevention group had at least one statin refill after diagnosis. There were no significant differences between groups for number of days between diagnosis and last refill, or between last refill and death. Two deaths were attributable to cardiovascular causes in each group.

Conclusions: Our retrospective cohort analysis of persons with incident poor-prognosis cancer describes diminished, but persistent statin refills after diagnosis. Neither timing of statin discontinuation nor cardiovascular mortality differed by prescribing indication. There may be an opportunity to reevaluate medication burden in persons taking statins for primary prevention, and it is unclear whether continuing statins prescribed for secondary prevention affects cardiovascular outcomes.

FIG. 1.

Flow diagram of generation of cohort of poor prognosis cancer patients.

FIG. 2A.

Superimposed Kaplan-Meier estimates of cumulative survival probability and cumulative time to last statin fill of overall cohort. Includes number of subjects at risk.

FIG. 2B.

Superimposed Kaplan-Meier estimates of cumulative survival probability and cumulative time to last statin fill of secondary prevention cohort. Includes number of subjects at risk.

FIG. 2C.

Superimposed Kaplan-Meier estimates of cumulative survival probability and cumulative time to last statin fill of primary prevention cohort. Includes number of subjects at risk.