Huabing Zhang, MD; Jorge Plutzky, MD; Stephen Skentzos, BA, BS; Fritha Morrison, MPH; Perry Mar, PhD; Maria Shubina, ScD; Alexander Turchin, MD, MS
Acknowledgment: The authors thank Dr. Robert Dluhy for his thoughtful review of the manuscript.
Grant Support: From the National Library of Medicine (5RC1LM010460), the Diabetes Action Research and Education Foundation, and the Chinese National Key Program of Clinical Science.
Potential Conflicts of Interest: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M12-1580.
Reproducible Research Statement: Study protocol and data set: Not available. Statistical code: Available from Dr. Turchin (e-mail, firstname.lastname@example.org).
Requests for Single Reprints: Alexander Turchin, MD, MS, Division of Endocrinology, Brigham and Women's Hospital, 221 Longwood Avenue, Boston, MA 02115; e-mail, email@example.com.
Current Author Addresses: Dr. Zhang: Department of Endocrinology, Peking Union Medical College Hospital, No.1 Shuaifuyuan, Wangfujing, DongCheng District, Beijing, 100730 China.
Dr. Plutzky: Director, The Vascular Disease Prevention Program, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, 77 Avenue Louis Pasteur, NRB 742, Boston, MA 02115.
Mr. Skentzos: 160 North Frances Street, Sunnyvale, CA 94086.
Ms. Morrison: Tulane University School of Public Health and Tropical Medicine, Department of Epidimiology, 1440 Canal Street, New Orleans, LA 70112-2699.
Dr. Mar: Clinical Informatics Research & Development, Partners Information Systems, 93 Worcester Street, Suite 201, Wellesley, MA 02481.
Drs. Shubina and Turchin: Division of Endocrinology, Brigham and Women's Hospital, 221 Longwood Avenue, Boston, MA 02115.
Author Contributions: Conception and design: H. Zhang, J. Plutzky, P. Mar, A. Turchin.
Analysis and interpretation of data: H. Zhang, J. Plutzky, A. Turchin.
Drafting of the article: H. Zhang.
Critical revision of the article for important intellectual content: H. Zhang, J. Plutzky, F. Morrison, P. Mar, M. Shubina, A. Turchin.
Final approval of the article: J. Plutzky, M. Shubina, A. Turchin.
Statistical expertise: M. Shubina.
Obtaining of funding: A. Turchin.
Administrative, technical, or logistic support: S. Skentzos, F. Morrison, P. Mar.
Collection and assembly of data: H. Zhang, S. Skentzos, P. Mar.
Zhang H, Plutzky J, Skentzos S, Morrison F, Mar P, Shubina M, et al. Discontinuation of Statins in Routine Care Settings: A Cohort Study. Ann Intern Med. 2013;158:526-534. doi: 10.7326/0003-4819-158-7-201304020-00004
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Published: Ann Intern Med. 2013;158(7):526-534.
Systematic data on discontinuation of statins in routine practice of medicine are limited.
To investigate the reasons for statin discontinuation and the role of statin-related events (clinical events or symptoms believed to have been caused by statins) in routine care settings.
A retrospective cohort study.
Practices affiliated with Brigham and Women's Hospital and Massachusetts General Hospital in Boston.
Adults who received a statin prescription between 1 January 2000 and 31 December 2008.
Information on reasons for statin discontinuations was obtained from a combination of structured electronic medical record entries and analysis of electronic provider notes by validated software.
Statins were discontinued at least temporarily for 57 292 of 107 835 patients. Statin-related events were documented for 18 778 (17.4%) patients. Of these, 11 124 had statins discontinued at least temporarily; 6579 were rechallenged with a statin over the subsequent 12 months. Most patients who were rechallenged (92.2%) were still taking a statin 12 months after the statin-related event. Among the 2721 patients who were rechallenged with the same statin to which they had a statin-related event, 1295 were receiving the same statin 12 months later, and 996 of them were receiving the same or a higher dose.
Statin discontinuations and statin-related events were assessed in practices affiliated with 2 academic medical centers. Utilization of secondary data could have led to missing or misinterpreted data. Natural-language–processing tools used to compensate for the low (30%) proportion of reasons for statin discontinuation documented in structured electronic medical record fields are not perfectly accurate.
Statin-related events are commonly reported and often lead to statin discontinuation. However, most patients who are rechallenged can tolerate statins long-term. This suggests that many of the statin-related events may have other causes, are tolerable, or may be specific to individual statins rather than the entire drug class.
National Library of Medicine, Diabetes Action Research and Education Foundation, and Chinese National Key Program of Clinical Science.
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