Treatment strategies and LDL cholesterol target attainment in patients with statin intolerance: Insights from the multicentre statin intolerance registry

Objective and methods: Statin intolerance (SI) is an important cause of insufficient low-density lipoprotein cholesterol (LDL-C) target attainment. Contemporary treatment strategies and symptoms in patients with SI are incompletely understood. We report baseline lipid-lowering therapies (LLTs) and LDL-C target attainment in the Statin Intolerance Registry, an observational, prospective, multicenter study that recruited 1,111 patients with SI between 2021 and 2023 in Germany. Results: The mean age was 66.1 (SD 9.9) years, 57.7 % were female. At study inclusion, 83.1 % received at least one LLT, and 47.0 % received combination LLT. A higher number of LLTs was associated with lower LDL-C, lower systolic blood pressure, more atherosclerotic disease, more elevations of creatine kinase and liver enzymes but not with impaired quality of life as measured by EuroQol (EQ-5D-5L). PCSK9 inhibitors were most frequently prescribed (48.0 %), followed by ezetimibe (39.2 %), statins (26.9 %), most commonly rosuvastatin, and bempedoic acid (25.4 %). Patients who had been prescribed multiple statins before were more likely to take a statin at baseline. Patients on a statin, even at low intensity, had lower LDL-C levels compared to patients without statin therapy (mean [SD] 2.4 [1.2] vs. 2.9 [1.6] mmol/L, p < 0.001). Significantly more men than women achieved the LDL-C target (21.7 % vs. 11.4 %, p <0.001, total cohort: 15.8 %). Conclusion: LDL-C target attainment is low in patients with SI, especially among women, despite high cardiovascular risk. The use of a greater number of LLTs, including statins, is not associated with reduced quality of life but is associated with lower LDL-C levels.