Discontinuation of Statins

Tue, 02 Apr 2013 00:00:00 GMT

Discontinuation of Statins in Routine Care Settings A Cohort Study

Zhang H, Plutzky J, Skentzos S, et al. — Tue, 02 Apr 2013 00:00:00 GMT

Chinese translation

Background:

Systematic data on discontinuation of statins in routine practice of medicine are limited.

Objective:

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.

Design:

A retrospective cohort study.

Setting:

Practices affiliated with Brigham and Women's Hospital and Massachusetts General Hospital in Boston.

Patients:

Adults who received a statin prescription between 1 January 2000 and 31 December 2008.

Measurements:

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.

Results:

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.

Limitations:

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.

Conclusion:

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.

Primary Funding Source:

National Library of Medicine, Diabetes Action Research and Education Foundation, and Chinese National Key Program of Clinical Science.

Statin Discontinuation and Intolerance: The Challenge of Lifelong Therapy

Grundy SM. — Tue, 02 Apr 2013 00:00:00 GMT

Statins are among the most widely prescribed drugs, but discontinuation rates are relatively high. In this issue, Zhang and colleagues used electronic health records to explore statin discontinuations among patients in 1 hospital system and found that many patients who discontinue statins could tolerate them if rechallenged. The editorialist discusses the study and advocates for better strategies to promote statin adherence.

Annals of Internal Medicine: Dyslipidemia Topic Collection

Discontinuation of Statins

Discontinuation of Statins in Routine Care Settings A Cohort Study

Statin Discontinuation and Intolerance: The Challenge of Lifelong Therapy