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%...

A New Look at Diagnosing Alzheimer’s Disease

More than years ago, the National Institute of Neurological and Communicative Disorders and Stroke and the Alzheimer’s and Related Disorders Association (now the Alzheimer’s Association) released diagnostic criteria for Alzheimer’s disease (AD). At the time, AD was thought of only as a dementia. The 1984 criteria stated that the ultimate AD diagnosis was dependent on pathology. Since that time, the basic concepts of AD have changed significantly, and researchers have uncovered important clues on the diagnosis of AD and dementia. Updating Diagnostic Criteria for Alzheimer’s The National Institute of Aging of the NIH and the Alzheimer’s Association recently called a meeting to discuss whether or not the diagnostic criteria required updating. Three subgroups were established to discuss the criteria, based on what would be the biggest changes in the concepts of AD (Table 1). These included that AD starts years and perhaps decades before dementia develops and symptoms are visible. The result of this collaboration was the establishment of new guidelines based on four articles collectively called the “National Institute on Aging/ Alzheimer’s Association Diagnostic Guidelines for Alzheimer’s Disease.” The document was published in the April 22, 2011 online edition of Alzheimer’s & Dementia. “The field is changing rapidly, and the hope is biomarkers will become more widely available and used in diagnoses.” “The pre-symptomatic phase of AD includes people who have laboratory evidence of the disease but no symptoms,” explains Guy M. McKhann, MD, who was a member of the group that updated the diagnostic criteria. “The minimal cognitive impairment (MCI) phase includes people with memory problems who haven’t reached the stage of being demented. The final phase includes those...