Statin deprescribing: a comprehensive review and development of a clinical algorithm for optimal patient management

BACKGROUND: Statins are widely used to prevent atherosclerotic cardiovascular disease through the reduction of low-density lipoprotein cholesterol. However, in patients with limited life expectancy or significant multimorbidity, the long-term benefits of statins may be reduced while the risks can increase. AIMS: The aim of this study was to evaluate the evidence supporting statin deprescribing and develop a clinical algorithm to guide appropriate discontinuation. METHODS: We conducted a systematic literature search in PubMed (18 November 2024) using the terms 'statins AND (deprescribing OR deprescription)'. Eligible studies reported statin deprescribing interventions and were analysed based on study design, population, outcomes and healthcare professional involvement. RESULTS: Fifty-six studies met the inclusion criteria. Among these, 65% were real-world studies, 17% narrative reviews, 9% systematic reviews, 11% randomised controlled trials (RCTs), and 2% a single case report. Study sample sizes ranged from 1 to 212 566 patients. Outcome assessment tools varied across studies; 61% employed database analyses to evaluate clinical, administrative and quality-of-life outcomes. Notably, 41% of studies reported favourable outcomes following statin deprescribing, suggesting that discontinuation was not associated with serious adverse events and was often linked to improved quality of life. A multidisciplinary team conducted the deprescribing intervention in 43% of cases. CONCLUSION: These findings support statin deprescribing as a safe and effective strategy in selected patients, particularly those with limited life expectancy or multiple comorbidities. Personalised, shared decision-making and multidisciplinary collaboration are essential to guide appropriate deprescribing. Further high-quality research, especially RCTs, is needed to consolidate current evidence and inform future clinical guidelines.