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Statin discontinuation common in high-risk patients
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ORLANDO, Fla. — A perceived lack of need is a major reason why patients with elevated CVD risk discontinue statin therapy, according to data presented at the American College of Cardiology Scientific Session.
In a new study, most high-risk patients who discontinued statins refused to resume therapy, according to the researchers.
“It’s important to discuss with your patient at the time that you start a statin or adjust the dose of the statin that if you perceive that you’re having side effects, you call to discuss those side effects,” Robert Rosenson, MD, director of cardiometabolic disorders at Icahn School of Medicine at Mount Sinai, told Cardiology Today.
Researchers analyzed data from 7,216 participants from the REGARDS study who reported taking a statin. Among the cohort, 15% reported discontinuing statin therapy.
“Unlike other studies like Framingham, this study is enriched in African-Americans and also contains a lot of white individuals as well,” Rosenson said in an interview.
Those who discontinued statins were stratified into four risk categories: diabetes without CVD, prior CVD, 10-year predicted CVD risk of at least 7.5% and 10-year predicted CVD risk of less than 7.5%. Surveys were conducted over the phone or on-site to collect information on why participants discontinued statin therapy and whether they would be willing to reinitiate treatment.
Among patients who discontinued their regimen, 27.6% of those with a history of CVD, 25.4% who had diabetes without CVD, 34.8% at high risk for CVD and 31.8% with a 10-year risk less than 7.5% said they made the decision because they did not believe they needed statin therapy.
In all four risk groups, more than half of those who discontinued statins, ranging from 51.2% in the diabetes group to 69.4% in the prior CVD group, were not willing to reinitiate treatment, the researchers found.
“This is problematic,” Rosenson told Cardiology Today. “Many people do not have a true statin muscle complaint. Many of them have arthritis and they worsen with the change in weather, and many people are influenced by what they read on the internet or hear in the news.”
Compared with participants with CVD risk less than 7.5%, those with diabetes (prevalence ratio = 1.52; 95% CI, 0.74-3.15), CVD (prevalence ratio = 0.97; 95% CI, 0.44-2.13) and 10-year CVD risk greater than 7.5% (prevalence ratio = 1.29; 95% CI, 0.68-2.64) were not more likely to reinitiate therapy.
“That’s why it’s important that the patient works with the physician to better understand and to determine whether consistent with the statin-muscle effect or not,” Rosenson said. “If not, then one has to pursue another evaluation which may be involving a neuromuscular specialist who can check for other causes of muscle weakness.” – by Darlene Dobkowski
Reference:
Mefford M, et al. Abstract 1140M-17. Presented at: American College of Cardiology Scientific Session; March 10-12, 2018; Orlando, Fla.
Disclosure: Rosenson reports he receives consultant fees/honoraria from Akcea, Kowa, Regeneron and Sanofi-Aventis and research/research grants from Akcea, Amgen, AstraZeneca and The Medicines Company.
Perspective
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Michael H. Davidson, MD
We really have to learn more about why people stop statins. That’s a big deal clinically. We know that people who stop taking statins have more adverse outcomes. We need to study this much more diligently and the many reasons why people stop taking statins. What’s important is that we need to figure out better ways strategically to make sure we can figure out how to get patients on statins longer term because ultimately that’s one of the big causes of outcomes. The deficiency of these therapies is not having long-term compliance.
This is just the tip of the iceberg. We have great therapies available to treat elevated LDL. We can improve outcomes so much greater if we can really figure out how to maintain compliance.
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