April 2nd, 2013

Lifelong Statin Sentence Now Includes Furloughs

Although the benefits of statins are among the best documented in all of medicine, continuous lifelong statin therapy is not always easy to achieve in clinical practice. Now a new retrospective study suggests that although clinical events causing temporary cessation of statin therapy occur often, most of these patients are later able to resume statin therapy.

In a paper published in Annals of Internal Medicine, researchers analyzed data from 107,835 patients with a statin prescription treated by physicians associated with Massachusetts General Hospital and Brigham and Women’s Hospital. Of these, 18,778 of these patients had documented statin-related events, resulting in 11,124 patients who stopped taking statins. Within a year more than half of these (6,579) were rechallenged with a statin, and most of these (92.2%) were taking a statin a year after the initial statin-related event.

Although, the authors acknowledged, it was impossible with their methods to fully understand how many patients really withdrew from statins and why, they concluded that many apparently statin-related events “may have other causes, are tolerable, or may be specific to individual statins rather than the entire drug class.” Because permanently stopping statins “could lead to many preventable cardiovascular events,” they write that “providers should consider rechallenging patients who report statin-related events to identify those who can continue taking them.”

In an accompanying editorial, Scott Grundy writes that lifelong treatment with statins “is a tall order for many persons.” Adherence to statins is further made difficult because of the clear presence of muscle weakness in some people taking statins, though the exact prevalence is not known and is disputed. Other possible adverse effects are liver injury, memory loss, and increased risk for diabetes, though Grundy wonders if these are true side effects.

Improved adherence is more likely in high-risk patients or in patients taking statins for secondary prevention, as “there is ample opportunity to monitor and promote adherence” in these patients when they see their physicians. For primary prevention, however, “adherence will probably emerge as a major issue.” Grundy observes that “the health care system is not fashioned to promote long-term drug adherence” in the United States.



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