A Closer Look at Statin Discontinuation

A Closer Look at Statin Discontinuation

According to current guideline recommendations, once patients are started on statins, they’re virtually mandated to continue taking them for the rest of their lives. This can represent a serious challenge for many patients. Many patients believe the symptoms they experience are the result of taking statins, but the clinical trials suggest the incidence of statin-related side effects is similar to placebo. Analyzing Statin Discontinuation Causes In a study published in Annals of Internal Medicine, my colleagues and I investigated the reasons for statin discontinuation and the role of statin-related events in routine care. The 8-year analysis involved more than 100,000 pa­tients who were prescribed a statin. More than half (53.1%) stopped taking a statin at least once during the course of treatment. Just over two-thirds had a reason documented in their records for statin discontinuation, with the most common reason listed as “no longer necessary.” Other reasons included cost, a change of statin requested by an insurance company, switching to another drug, or patients not wanting to take a statin. Importantly, 17.4% of study participants had a documented statin-related event during the study, the most common being myalgia or myopathy. Of those with these events, most stopped taking the statin temporarily. More than half who stopped therapy were rechallenged with a statin over the following 12 months. Of these patients, 92.2% were taking a statin 12 months after the original statin-related event. For those who stopped taking statins for reasons other than a statin-related event, about two-thirds had another statin prescription over the following 12 months; most of these were for a different statin. Of those who restarted, 98.0%...

More Patient Encounters Benefit Diabetes Care

As the epidemic of diabetes continues to grow, it’s becoming increasingly important for healthcare providers to find effective strategies to minimize microvascular and macrovascular complications associated with the disease. Unfortunately, many patients with diabetes do not have these disease components under control. Intriguing New Data In the Archives of Internal Medicine, my colleagues and I had a study published in which we retrospectively analyzed more than 26,000 patients with diabetes and hyperglycemia, hypertension, and/or hyperlipidemia who received care in primary care settings. We wanted to determine if diabetes control was improved with a greater frequency of patient encounters. A strong association between encounter frequency and A1C, blood pressure (BP), and LDL cholesterol control in patients with diabetes was observed (Table 1). Doubling the time between physician encounters was also found to increase median time to A1C, BP, and LDL cholesterol targets. More frequent opportunities for medication intensification are likely an important factor in our findings (Table 2). They may also likely improve medication adherence and increase opportunities for providers to offer lifestyle coaching or other education that can further enhance diabetes control. Potential for Great Benefits Considering that more frequent encounters in patients with diabetes would increase the demands on healthcare resources, increasing the frequency of encounters may require innovative approaches to delivering care. For example, medical homes may help coordinate the care of patients. In addition, some interactions could be accomplished through group visits, telephone, fax, email, or internet communications. Midlevel providers can also alleviate physician workloads without negatively affecting patient outcomes. Until guidelines provide more data or recommendations on how frequently patients with diabetes should be seen...