Read the complete EBM Focus/earn CME credit
Reference: Ann Intern Med 2013 Apr 2;158(7):526
Statin therapy has been shown to be effective for both primary and secondary cardiovascular disease prevention (Cochrane Database Syst Rev 2013 Jan 31;(1):CD004816) (Arch Intern Med 2004 Jul 12;164(13):1427), and discontinuation has been associated with increased event rates (JAMA 2007 Jan 10;297(2):177). Nevertheless, discontinuation is common, often due to adverse effects associated with statin treatment. A recent, retrospective cohort study investigated the rates of discontinuing and restarting statins in 107,835 patients who received prescriptions from 2000 to 2008.
Statin therapy was discontinued at least temporarily in 53% of patients overall, while only 17% experienced statin-related adverse events. Of those who did have events, 59% discontinued treatment. The most common events were myalgia and myopathy or other musculoskeletal or connective tissue disorders, pain and fatigue. A total of 6,579 patients who stopped statins due to a statin-related adverse event then restarted statins, with 41% restarting the same drug that had been discontinued. 92% of the patients restarting statins remained on treatment at 1 year after the original event. About a third of those who restarted on their original statin were taking the same or a higher dose at 1 year. Of the patients who discontinued for reasons other than adverse events and then restarted, 98% remained on treatment at 1 year after the original discontinuation.
These results suggest that the majority of patients who restart statins may find them tolerable over the long term, even if they have a history of adverse reactions. This information may help clinicians counsel patients regarding the risks and benefits of continued statin therapy.
For more information, see the Statins topic in DynaMed.