Statin Treatment Beneficial for High-Risk Patients Despite Adverse Reactions

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Statins have been proven to be beneficial for reducing mortality in patients at high cardiovascular risk.
Statins have been proven to be beneficial for reducing mortality in patients at high cardiovascular risk.

Continuing statins despite experiencing adverse effects is associated with a lower incidence of cardiovascular events and death, according to a study published in Annals of Internal Medicine.1

The retrospective study included 28,266 individuals ≥ 18 years of age receiving statin prescriptions, being seen by primary care providers, and for whom an adverse reaction was documented in their medical record. The most common reported adverse events included myalgia or myopathy, musculoskeletal and connective tissue disorders other than myalgia or myopathy, hepatobiliary and other gastrointestinal disorders, and drug intolerance.

A total of 19,989 (70.7%) continued to receive prescriptions for statins vs 8277 (29.3%) who did not.  Those who continued with statin therapy despite adverse reactions had a 10% to 20% lower incidence of both cardiovascular events and all-cause mortality.

The researchers note that continuing statins after an adverse reaction may not be the optimal course for everyone. Both the absolute risk and symptom severity must be weighed against the potential benefit of continuing statin therapy. In addition, continued statin therapy may not be appropriate for patients with low cardiovascular risk. The most recent guidelines recommend statins for most patients with a 10-year cardiovascular risk of 7.5% or greater.

Limitations

Although both low- and high-risk participants were included in the study, the average patient was considered high-risk. Future studies should establish the cardiovascular risk threshold to determine the risk vs benefit of resumption of statins after an adverse reaction.

Disclosures

Dr Turchin reports receiving grants from Sanofi-Aventis Groupe and Merck. Dr Plutzky reports serving as a consultant to Amgen, AstraZeneca, Merck, Pfizer, and Sanofi.

References

  1. Zhang H, Plutzky J, Shubina M, Turchin A. Continued statin prescriptions after adverse reactions and patient outcomes: a cohort study. Ann Intern Med. 2017;167(4):221-227.
  2. Stone NJ, Robinson JG, Lichtenstein AH, et al; American College of Cardiology/American Heart Association Task Force on Practice Guidelines. 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014:129:S1-45. 
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