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.

Statin-Discontinuation-Callout

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% were still taking the statin 12 months later.

Ensuring Statin Use for the Long Term

The data from our study confirm that discontinuation rates with statins are relatively high, but we should be reassured that most patients can tolerate these drugs for the long term when they are rechallenged. Many statin-related events may have other causes, are tolerable, or may be specific to individual statins rather than the entire drug class. Given their established efficacy to reduce all-cause mortality, it’s clear that restarting patients on statins is worth considering for many patients who discontinued them after mild to moderate adverse reactions. With appropriate management of statin-related events, it’s hoped that clinicians and patients can work together to find solutions that ensure statin use for the long term in those who need it.

References

Zhang H, Plutzky J, Skentzos S, et al. Discontinuation of statins in routine care settings: a cohort study. Ann Intern Med. 2013;158:526-534. Available at: http://annals.org/article.aspx?articleid=1671715.

Grundy SM. Statin discontinuation and intolerance: the challenge of lifelong therapy. Ann Intern Med. 2013;158:562-563.

Maningat P, Gordon BR, Breslow JL. How do we improve patient compliance and adherence to long-term statin therapy? Curr Atheroscler Rep. 2013;15:291.

Cohen JD, Brinton EA, Ito MK, Jacobson TA. Understanding Statin Use in America and Gaps in Patient Education (USAGE): an internet-based survey of 10,138 current and former statin users. J Clin Lipidol. 2012;6:208-215.