Most Statin-Intolerant Patients Can Be Restarted on Lipid-Lowering Drugs

September 11, 2013

CLEVELAND, OH — Most patients who stop statin therapy because of adverse side effects can be successfully restarted on the LDL-lowering drugs, according to the experience of one clinical center[1].

At the Cleveland Clinic, nearly three-quarters of patients with prior statin intolerance were able to successfully tolerate a statin, with most of these patients taking the drug on a daily basis and a smaller percentage of patients following an intermittent dosing regimen. Of the 1605 patients referred to the clinic for statin intolerance, 72.5% were successfully rechallenged and remained on the medication for a median of 31 months.

"The most important finding of this study is that most statin-intolerant patients can tolerate some form of statin therapy and that intermittent statin use can be an option for some patients to achieve improvement in serum lipid levels," write Dr Warner Mampuya (Cleveland Clinic, OH) and colleagues in the September 2013 issue of the American Heart Journal.

Of the 1605 statin-intolerant patients referred to their center, 1014 were restarted again on a daily statin, the most common medication for the rechallenge being rosuvastatin (Crestor, AstraZeneca). Senior researcher Dr Leslie Cho (Cleveland Clinic) told heartwire the patients were slowly rechallenged with the statin, starting the medication once per week. This was gradually increased to twice per week, then three times per week, until they were once again taking a statin daily.

Another 149 patients were restarted on a statin with an intermittent dosing strategy, which was defined as any statin prescription that is not taken daily. Interestingly, those on the intermittent strategy had a 27.7% reduction in LDL cholesterol, a drop that was significantly larger than the 21.3% reduction among patients rechallenged with a daily statin.

There was a trend toward a reduction in all-cause mortality for patients on the daily and intermittent statin dosing compared with the 442 patients who were unable to restart statin therapy, but the reduction did not reach statistical significance.

"This study is the largest to date to review different treatment regimens for patients with documented statin intolerance and the impact on LDL cholesterol," state the researchers. "It confirms previous reports that most patients with a history of statin intolerance can tolerate subsequent statin trials, achieve significant LDL-cholesterol reductions, and attain LDL-cholesterol goals."

Overall, statins were discontinued for 27.5% of the statin-intolerant patients. For these patients, the most common adverse effect was myalgia, while 15.2% reported weakness/fatigue, 11.1% had elevated hepatic enzymes, another 11.3% had gastrointestinal complaints, and 8.6% reported joint pain.

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