Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Continued Statin Rx’s After an Adverse Reaction

Ann Intern Med; ePub 2017 Jul 25; Zhang, et al

Continuing patients on statin therapy after an adverse reaction is associated with a lower incidence of death and cardiovascular events, a recent study found. The retrospective cohort study included 28,266 patients with a presumed adverse reaction to a statin between 2000 and 2011 and examined the relationship between continuation of statin therapy (any prescription within 12 months after an adverse reaction) and clinical outcomes. Primary composite outcome was time to a CV event or death. Researchers found:

  • 19,989 (70.7%) patients continued receiving statin prescriptions after the adverse reaction.
  • 4 years after the presumed adverse events, the cumulative incidence of the composite primary outcome was 12.2% for patients with continued statin prescriptions vs 14% for those without them.
  • Among 7,604 patients in a secondary analysis for whom a different statin was prescribed after the adverse reaction, 2,014 (26.5%) had an adverse reaction to the second statin; however, 1,696 (84%) of those patients continued receiving statin prescriptions.

Citation:

Zhang H, Plutzky J, Shubina M, Turchin A. Continued statin prescriptions after adverse reactions and patient outcomes: A cohort study. [Published online ahead of print July 25, 2017]. Ann Intern Med. doi:10.7326/M16-0838.

Commentary:

Statins have documented efficacy in decreasing cardiovascular events in patients who have established CV disease and in those who are at high risk of developing CV disease. However, 25% to 50% of patients who are started on a statin stop taking the statin within a year, and by 2 years that number may increase to 75%.1 Common adverse reactions to statins include myalgias, GI side effects, and neurologic side effects. They may also increase the risk of diabetes. Often, when patients stop their medication and are rechallenged with a statin, their symptoms do not return. The current study shows that 30% of patients stop taking statins due to a presumed side effect, but patients who continued to receive statins had a 10% to 20% lower incidence of CV events and death from any cause. In addition, of patients rechallenged with a different statin, only about one-fourth of them continued to have an adverse effect. The conclusion here is clear: while we do not want patients to be made miserable from medication side effects, most of the side effects from statins are relatively mild and do not return when another statin is tried. Furthermore, patients who continue to receive a statin have a lower rate of CV events than those who do not. —Neil Skolnik, MD

  1. Phan K, Gomez YH, Elbaz L, Daskalopoulou SS. Statin treatment non-adherence and discontinuation: Clinical implications and potential solutions. Curr Pharm Des. 2014;20:6314-24.

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