Statins and Pain in Older Cancer Patients

November 6, 2014

Statins and Pain in Older Cancer Patients

  1. Allan S. Brett, MD

In patients older than 80, statin use was associated with higher odds of general pain.

  1. Allan S. Brett, MD

Determining whether statins are responsible for nonspecific aches and pains can be difficult, especially in elders. Australian researchers explored this association in a cohort of 385 older cancer patients (age, ≥70) who were referred to a geriatric oncology outpatient unit. Half the patients were referred for palliative care, 36% were taking statins, and half the statin use was for primary prevention.

Self-reported general pain was assessed on a 10-point visual analog scale. In the oldest patients (age, ≥80), having a pain score ≥5 was associated significantly with statin use (odds ratio, 4.1), after adjustment for variables including age, comorbidities, and analgesic use. In the younger group (age range, 70–79), no significant association was observed.

Comment

Two points emerge from this study. First, many older cancer patients were receiving statins — often for primary prevention. This observation suggests therapeutic inertia, in which clinicians fail to stop unnecessary medications; indeed, it's not clear that statins should be prescribed for primary prevention even in 80-year-old patients without cancer. Second, although this study doesn't prove causality, it supports the clinical impression of many clinicians that older patients are especially prone to musculoskeletal side effects of statins.

Editor Disclosures at Time of Publication

  • Disclosures for Allan S. Brett, MD at time of publication Nothing to disclose

Citation(s):

Reader Comments (2)

Neil Stone Physician, Cardiology, Northwestern

The new guidelines didn't recommend statins for primary prevention in those more than 75. For those under 75 in primary prevention with a 7.5% or more 10 year risk, the guidelines noted that there was evidence for benefit if statins were prescribed. But importantly, they insisted on a clinician-patient "risk discussion" before a statin was prescribed. This was designed to look at adequacy of other risk factor control, lifestyle, discuss the potential for benefit and the potential for adverse effects and drug/drug interactions and elicit informed patient preference. Thus, the guidelines would most likely not recommend statins for primary prevention in 80+ yo patients with cancer. For those who want to know what the guidelines say in various situations, download the free ASCVD risk estimator from the ACC at www.cardiosource.com Note: I am the lead author for the 2013 Cholesterol Guidelines.

sanjai sinha Physician, Internal Medicine, Weill Cornell Medical College and New York Presbyterian Hospital

Dr. Brett mentions that, "It's not clear that statins should be prescribed for primary prevention in 80-year old patients" - doesn't this fly in the face of the 10-year ASCVD risk calculation that is the current standard of care when determining appropriateness of statin use? Anyone at 80 years old will have >7.5% risk of an ASCVD even in the next 10 years, and thus should recieve a statin to prevent stroke, CAD, and other vascular events.

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