The debate on whether terminally-ill patients should be given supposed "life-enhancing" drugs, which sometimes come with painful side effects, is an ongoing one, and many palliative care researchers are recommending an end to the aggressive medications among patients nearing the end of their life. Now, new research exploring the benefits of ending statin use for cholesterol management in terminally ill patients has found that doing so would not only improve their quality of life, but also prolong it.
Statins, also called HMG-CoA reductase inhibitors, are a class of drugs that lower cholesterol levels in the blood. They work to prevent high cholesterol levels from blocking the arteries that supply blood to the heart, therefore, also preventing a heart attack. They are generally prescribed for patients with high cholesterol and those prone to cardiovascular diseases. But because high cholesterol is not the only factor that may cause these diseases, many doctors recommend adopting healthier lifestyles before statins.
Now, researchers from the University of Colorado Cancer Center and the Palliative Care Research Cooperative Group have shown that ending statin use in patients suffering from cancer or other terminal illnesses led to an improved, longer life with reduced costs. Their results were presented on Friday at the annual meeting of the American Society for Clinical Oncology (ASCO).
"Based on the study, for patients that are on medications for primary or secondary prevention — for example, those who have not just had a stroke or heart attack — and have a limited life expectancy of less than one year, I would recommend discussing with their physicians the potential to stop taking statins," said Dr. Jean Kutner, investigator and professor of medicine at the University of Colorado School of Medicine, in a press release.
"We tend to be so focused on which medications are effective to start, but there's no research on if and when to stop them. It's a new line of investigation. Especially in the context of end-of-life care, we believe there are many situations in which preventative drugs may be doing more harm than good," she said, adding that the effect of ending use of medications for osteoporosis, blood clots, high blood pressure, and diabetes also need to be evaluated.
The study tracked 381 patients who were terminally ill and had been given less than a year to live. All the patients had been taking statins for almost three months. The study required that half of them abstain from statins. For the next year, the researchers looked at survival rates, cardiovascular events, and changes in quality of life.
The average survival rate among patients who continued statins was 190 days, compared to 229 days for those who had stopped taking them. Those who discontinued taking the drugs also reported a better quality of life in terms of psychological wellbeing. Abstaining also reduced costs for patients by $716 for name brand drugs and $629 for generics per person over the course of the trial. The researchers calculated that savings could amount to $603 million a year if terminally ill patients in the U.S. ended statin use.
“One thing we found during the study was clinicians saying, 'Hey I never thought about stopping people's statins,'" Kutner concluded. "The study raised awareness. Here's a setting in which these drugs may not be doing most patients any good anymore, and bringing up the subject of stopping unneeded medications offers the opportunity for shared decision-making. There's power in individual choice.”