02 Apr Discontinuation of Statins in Routine Care Settings: A Cohort Study
Director of Informatics Research
Assistant Professor, Harvard Medical School
Endocrinology, Diabetes and Hypertension
Brigham and Women’s Hospital Boston, MA
MedicalResearch.com: What are the main findings of the study?
Dr. Turchi: A large number of patients – 17% of individuals included in our study – report side effects to statins in routine care settings. Nearly 60% of these patients stopped the statin at least temporarily. However, overwhelming majority of patients who stopped taking a statin after experiencing a possible side effect, could tolerate a statin long-term if they tried taking one again. In other words, it appears that many statin-related events are tolerable, specific to individual statins or have other causes. These findings are consistent with the current guidelines that urge a conservative approach to statin discontinuation. They are particularly important because statins have been convincingly shown to save lives – they decrease all-cause mortality, and also cardiovascular mortality and incidence of cardiovascular events in patients with ischemic heart disease and / or elevated cholesterol levels.
MedicalResearch.com: Were any of the findings unexpected?
Dr. Turchi: Based on our clinical experience, we expected to see some degree of tolerability of statins in patients who previously stopped them because of possible side effects. However, the sheer magnitude – more than 90% of patients who tried a statin again were able to take it long-term – was a surprise. These results underscore how important it is to consider another trial of a statin – possibly a different statin or the same statin at a lower dose – for patients who have stopped a statin because of a possible adverse reaction.
MedicalResearch.com: What should clinicians and patients take away from your report?
Dr. Turchi: Both clinicians and patients should note that a re-trial of a statin should be considered in individuals who have experienced mild to moderate symptoms that were thought to be due to a statin. Not everyone would be a candidate; restarting a statin would not be appropriate, for example, in someone who had a life-threatening reaction, such as rhabdomyolysis. Therefore the findings of our study should not lead to a hard and fast rule but rather be a factor taken into consideration when evaluating the whole patient and their particular circumstances.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Dr. Turchi: Our study was based on observational data. Its results should be confirmed with an interventional clinical trial aimed to determine whether rechallenging patients who stopped their statins after a possible side effect improves important clinical outcomes, such as incidence of cardiovascular events and / or death. It is also important to continue to look into other reasons why statins may be stopped by patients and their clinicians, and how unnecessary discontinuation of statins can be prevented or minimized.
Discontinuation of Statins in Routine Care Settings: A Cohort Study
Huabing Zhang, MD; Jorge Plutzky, MD; Stephen Skentzos, BA, BS; Fritha Morrison, MPH; Perry Mar, PhD; Maria Shubina, ScD; and Alexander Turchin, MD, MS
Ann Intern Med 2 April 2013: Vol. 158, No. 158, pp. I-40