Treatment strategies in patients with statin intolerance: The Cleveland Clinic experience

被引:154
作者
Mampuya, Warner M. [1 ]
Frid, David [2 ]
Rocco, Michael [2 ]
Huang, Julie [2 ]
Brennan, Danielle M. [2 ]
Hazen, Stanley L. [2 ]
Cho, Leslie [2 ]
机构
[1] Ctr Hosp Univ Sherbrooke 3001, Serv Cardiol, Sherbrooke, PQ, Canada
[2] Cleveland Clin, Dept Prevent Cardiovasc Med, Cleveland, OH 44195 USA
关键词
ALTERNATE-DAY; WEEKLY ROSUVASTATIN; 20; MG; DISCONTINUATION; ATORVASTATIN; TOLERABILITY; CHOLESTEROL; EFFICACY; THERAPY; TRIALS;
D O I
10.1016/j.ahj.2013.06.004
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background Statin therapy is a proven effective treatment of hyperlipidemia. However, a significant number of patients cannot tolerate statins. This study was conducted to review treatment strategies for patients intolerant to statin therapy with a focus on intermittent statin dosing. Methods and results We performed a retrospective analysis of medical records of 1,605 patients referred to the Cleveland Clinic Preventive Cardiology Section for statin intolerance between January 1995 and March 2010 with at least a 6-month follow-up. The changes in lipid profile, achievement of low-density lipoprotein cholesterol (LDL-C) goals, and statin tolerance rate were analyzed. Most (72.5%) of patients with prior statin intolerance were able to tolerate a statin for the median follow-up time of 31 months. Patients on intermittent statin dosing (n = 149) had significantly lower LDL-C reduction compared with daily dosing group (n = 1,014; 21.3% +/- 4.0% vs 27.7% +/- 1.4%, P < .04). However, compared with the statin discontinued group (n = 442), they had a significantly higher LDL-C reduction (21.3% +/- 4.0% vs 8.3 +/- 2.2%, P < .001), and a significantly higher portion achieved their Adult Treatment Panel III goal of LDL-C (61% vs 44%, P < .05). There was a trend toward a decrease in all-cause mortality at 8 years for patients on daily and intermittent statin dosing compared with those who discontinued statin (P = .08). Conclusions Most patients with previous statin intolerance can tolerate subsequent trial of statin. A strategy of intermittent statin dosing can be an effective therapeutic option in some patients and may result in reduction in LDL-C and achievement of LDL-C goals.
引用
收藏
页码:597 / 603
页数:7
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