Continuing statins after adverse event associated with reduced risk for death
The study's findings may help physicians engage in a balanced discussion with patients about the benefits and risks of continuing statin therapy after an adverse reaction.
Patients who continued to receive statin prescriptions after an adverse reaction had a 10% to 20% lower incidence of both cardiovascular events and death from any cause, a study found.
Researchers conducted a retrospective cohort study among primary care practices affiliated with two academic medical centers that treated patients who had an adverse reaction to a statin between 2000 and 2011. Adverse reactions included myalgias, myopathies, or other musculoskeletal and connective tissue disorders; drug intolerance; and hepatobiliary, gastrointestinal, or nervous system disorders, among other events. The primary composite outcome was time to a myocardial infarction or stroke, or to death. Results were published July 26 by Annals of Internal Medicine.
A total of 28,266 patients were included in the study. Of these, 19,989 (70.7%) continued receiving statin prescriptions after the adverse reaction and 8,277 did not. Four years after the presumed adverse event, the cumulative incidence of the composite primary outcome was 12.2% for patients with continued statin prescriptions, compared with 13.9% for those without them (difference, 1.7%; 95% CI, 0.8% to 2.7%; P<0.001). In a secondary analysis of 7,604 patients for whom a different statin was prescribed after the adverse reaction, 2,014 (26.5%) had a documented adverse reaction to the second statin, but 1,696 (84.2%) of those patients continued receiving statin prescriptions.
The authors wrote that the findings may help physicians engage in a balanced discussion about the benefits and risks of continuing statin therapy after an adverse reaction.
“Whether therapy should be continued after an adverse reaction is an important decision that must take into account the balance of potential benefits and risks to the patient,” the authors wrote. “This study's findings may help patients and their clinicians inform their choice of treatment to best fit each patient's circumstances.”
In a related commentary, Steven E. Nissen, MD, wrote that Internet sources that criticize statins have led to low compliance rates and the widespread advocacy of unproven alternative cholesterol-lowering therapies.