The Impact of Statin Intolerance in Lipid Clinic Patients
Affiliation(s)
1 University of Liverpool (Medical School), Liverpool, UK. 2 Clinical Biochemistry and Metabolic Medicine Royal Liverpool and Broadgreen University Hospital NHS Trust, Liverpool, UK.
1 University of Liverpool (Medical School), Liverpool, UK. 2 Clinical Biochemistry and Metabolic Medicine Royal Liverpool and Broadgreen University Hospital NHS Trust, Liverpool, UK.
ABSTRACT
Context: Cardiovascular disease is a very common and serious problem in the western world. Statin drug therapy is used in primary, secondary prevention and familial hypercholesterolemia. However, these are frequently associated with adverse effects, causing poor adherence and thus putting patients at risk for future cardiovascular events. Aim: The objective of this study was to review the statin intolerance in lipid patients and to assess the impact of alternative lipid lowering therapy on lipid parameters and cardiovascular outcome in statin intolerant patients. Methodology: 50 patients attending the out-patient lipid clinic of our hospital with statin intolerance were identified. Clinical data on the study patients were gathered retrospectively relating to statin intolerance and the clinical effectiveness of alternative lipid lowering therapy on lipid parameters and cardiovascular outcome. Results: Rosuvastatin was the most intolerable whereas pravastatin or fluvastatin was the most tolerable statin in our study patients. Myalgia was the commonly reported adverse effect of statin. The low dose statin monotherapy or combination of low dose statin and ezetemibe was the most tolerable alternative lipid lowering therapy in statin intolerant patients. After an average period of 10 months of initiation of alternative lipid lowering therapy; combination of low dose statin plus ezetimibe showed the largest reduction in serum total cholesterol and low-density lipoprotein (LDL) cholesterol levels. Conclusions: Pravastatin should be preferred in statin intolerant patients. A combination of low dose statin plus ezetimibe appeared to be the most tolerable and clinically effective therapy in statin intolerant patients.
KEYWORDS
Statin Intolerance, Alternative Lipid Lowering Therapy, Low-Density Lipoprotein (LDL), Total Cholesterol
Statin Intolerance, Alternative Lipid Lowering Therapy, Low-Density Lipoprotein (LDL), Total Cholesterol
Cite this paper
Williams, K. and Mishra, V. (2015) The Impact of Statin Intolerance in Lipid Clinic Patients. International Journal of Clinical Medicine, 6, 314-321. doi: 10.4236/ijcm.2015.65040.
Williams, K. and Mishra, V. (2015) The Impact of Statin Intolerance in Lipid Clinic Patients. International Journal of Clinical Medicine, 6, 314-321. doi: 10.4236/ijcm.2015.65040.
References
[1] British Heart Foundation (2008) European Cardiovascular Disease Statistics. London. [2] Ferdinand, K.C. (2011) Are Cardiovascular Benefits in Statin Lipid Affects Dependent on Baseline Lipid Levels? Current Atherosclerosis Reports, 13, 64-72.
http://dx.doi.org/10.1007/s11883-010-0149-9 [3] Steingo, L. (1993) Epidemiology of Hyperlipidemia and the Efficacy of Pravastatin Therapy. Current Therapeutic Research—Clinical and Experimental, 54, 290-299.
http://dx.doi.org/10.1016/S0011-393X(05)80629-0 [4] Yusuf, P.S., Hawken, S., Ounpuu, S., Dans, T., Avezum, A. and Lanas, F. (2004) Effect of Potentially Modifiable Risk Factors Associated with Myocardial Infarction in 52 Countries (the INTERHEART Study): Case-Control Study. The Lancet, 364, 937-952.
http://dx.doi.org/10.1016/S0140-6736(04)17018-9 [5] Gotto Jr., A.M. and Moon, J.E. (2012) Management of Cardiovascular Risk: The Importance of Meeting Lipid Targets. American Journal of Cardiology, 110, 3A-14A.
http://dx.doi.org/10.1016/j.amjcard.2012.04.002 [6] Minder, C.M., Blaha, M.J., Horne, A., Michos, E.D., Kaul, S. and Blumenthal, R.S. (2012) Evidence-Based Use of Statins for Primary Prevention of Cardiovascular Disease. American Journal of Medicine, 125, 440-446.
http://dx.doi.org/10.1016/j.amjmed.2011.11.013 [7] NICE (2010) Lipid Modifications: Cardiovascular Risk Assessment and the Modification of Blood Lipids for the Primary and Secondary Prevention of Cardiovascular Disease. UK [8] Alberton, M., Wu, P., Druyts, E., Briel, M. and Mills, E.J. (2012) Adverse Events Associated with Individual Statin Treatments for Cardiovascular Disease: An Indirect Comparison Meta-Analysis. QJM, 105, 145-157.
http://dx.doi.org/10.1093/qjmed/hcr158 [9] Mills, E.J., Wu, P., Chong, G., Ghement, I., Singh, S., Akl, E.A., Eyawo, O., Guyatt, G., Berwanger, O. and Briel, M.(2011) Efficacy and Safety of Statin Treatment for Cardiovascular Disease: A Network Meta-Analysis of 170,255 Patients from 76 Randomized Trials. QJM, 104, 109-124.
http://dx.doi.org/10.1093/qjmed/hcq165 [10] Stone, N.J., Robinson, J., Lichtenstein, A.H., Merz, C.N., Blum, C.B., Eckel, R.H., et al. (2013) ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation, 129, S1-S45. [11] Mancini, G.B.J., Baker, S., Bergeron, J., Fitchett, D., Frohlich, J., Genest, J., Gupta, M., Hegele, R.A., Ng, D. and Pope, J. (2011) Diagnosis, Prevention, and Management of Statin Adverse Effects and Intolerance: Proceedings of a Canadian Working Group Consensus Conference. Canadian Journal of Cardiology, 27, 635-662.
http://dx.doi.org/10.1016/j.cjca.2011.05.007 [12] Law, M. and Rudnicka, A.R. (2006) Statin Safety: A Systematic Review. American Journal of Cardiology, 97, S52-S60.
http://dx.doi.org/10.1016/j.amjcard.2005.12.010 [13] JBS3 Board (2014) Joint British Societies’ Consensus Recommendations for the Prevention of Cardiovascular Disease (JBS3). Heart, 100, ii1-ii67. [14] NICE (2014) Lipid Modification: Cardiovascular Risk Assessment and the Modification of Blood Lipids for the Primary and Secondary Prevention of Cardiovascular Disease. NICE, UK. [15] Bays, H. (2005) Statin Safety: An Overview and Assessment of the Data. American Journal of Cardiology, 97, S6-S26.
http://dx.doi.org/10.1016/j.amjcard.2005.12.006 [16] Gaist, D., Rodríguez, L.A., Huerta, C., Hallas, J. and Sindrup, S.H. (2001) Lipid-Lowering Drugs and the Risk of Myopathy: A Population-Based Follow-Up Study. Epidemiology, 12, 565-569.
http://dx.doi.org/10.1097/00001648-200109000-00017 [17] Thompson, P.D., Clarkson, P.M. and Rosenson, R.S. (2006) An Assessment of Statin Safety by Muscle Experts. American Journal of Cardiology, 97, S69-S76.
http://dx.doi.org/10.1016/j.amjcard.2005.12.013 [18] Rosenson, R.S. (2004) Current Overview of Statin-Induced Myopathy. American Journal of Medicine, 116, 408-416.
http://dx.doi.org/10.1016/j.amjmed.2003.10.033 [19] Keogh, A., Macdonald, P., Kaan, A., Aboyoun, C., Spratt, P. and Mundy, J. (2000) Efficacy and Safety of Pravastatin versus Simvastatin after Cardiac Transplantation. Journal of Heart and Lung Transplantation, 19, 529-537.
http://dx.doi.org/10.1016/S1053-2498(00)00077-2 [20] Hippisley-Cox, J. (2010) Unintended Effects of Statins in Men and Women in England and Wales: Population Based Cohort Study Using the QResearch Database. BMJ, 340, c2197.
http://dx.doi.org/10.1136/bmj.c2197 [21] Carter, A.A., Gomes, T., Camacho, X., Juurlink, D.N., Shah, B.R. and Mamdani, M.M. (2013) Risk of Incident Diabetes among Patients Treated with Statins: Population Based Study. BMJ, 346, f2610.
http://dx.doi.org/10.1136/bmj.f2610 [22] Cholesterol Treatment Trialists’ (CTT) Collaboration (2010) Efficacy and Safety of More Intensive Lowering of LDL Cholesterol: A Meta-Analysis of Data from 170 000 Participants in 26 Randomised Trials. Lancet, 376, 1670-1681.
http://dx.doi.org/10.1016/S0140-6736(10)61350-5 [23] Kimberly, A.G., Monroe, A.K., Sharma, R., Ranasinghe, P.D., Chelladurai, Y. and Robinson, K.A. (2014) Effectiveness of Combination Therapy with Statin and Another Lipid-Modifying Agent Compared with Intensified Statin Monotherapy. Annals of Internal Medicine, 160, 468-476.
http://dx.doi.org/10.7326/M13-2526
[1] British Heart Foundation (2008) European Cardiovascular Disease Statistics. London. [2] Ferdinand, K.C. (2011) Are Cardiovascular Benefits in Statin Lipid Affects Dependent on Baseline Lipid Levels? Current Atherosclerosis Reports, 13, 64-72.
http://dx.doi.org/10.1007/s11883-010-0149-9 [3] Steingo, L. (1993) Epidemiology of Hyperlipidemia and the Efficacy of Pravastatin Therapy. Current Therapeutic Research—Clinical and Experimental, 54, 290-299.
http://dx.doi.org/10.1016/S0011-393X(05)80629-0 [4] Yusuf, P.S., Hawken, S., Ounpuu, S., Dans, T., Avezum, A. and Lanas, F. (2004) Effect of Potentially Modifiable Risk Factors Associated with Myocardial Infarction in 52 Countries (the INTERHEART Study): Case-Control Study. The Lancet, 364, 937-952.
http://dx.doi.org/10.1016/S0140-6736(04)17018-9 [5] Gotto Jr., A.M. and Moon, J.E. (2012) Management of Cardiovascular Risk: The Importance of Meeting Lipid Targets. American Journal of Cardiology, 110, 3A-14A.
http://dx.doi.org/10.1016/j.amjcard.2012.04.002 [6] Minder, C.M., Blaha, M.J., Horne, A., Michos, E.D., Kaul, S. and Blumenthal, R.S. (2012) Evidence-Based Use of Statins for Primary Prevention of Cardiovascular Disease. American Journal of Medicine, 125, 440-446.
http://dx.doi.org/10.1016/j.amjmed.2011.11.013 [7] NICE (2010) Lipid Modifications: Cardiovascular Risk Assessment and the Modification of Blood Lipids for the Primary and Secondary Prevention of Cardiovascular Disease. UK [8] Alberton, M., Wu, P., Druyts, E., Briel, M. and Mills, E.J. (2012) Adverse Events Associated with Individual Statin Treatments for Cardiovascular Disease: An Indirect Comparison Meta-Analysis. QJM, 105, 145-157.
http://dx.doi.org/10.1093/qjmed/hcr158 [9] Mills, E.J., Wu, P., Chong, G., Ghement, I., Singh, S., Akl, E.A., Eyawo, O., Guyatt, G., Berwanger, O. and Briel, M.(2011) Efficacy and Safety of Statin Treatment for Cardiovascular Disease: A Network Meta-Analysis of 170,255 Patients from 76 Randomized Trials. QJM, 104, 109-124.
http://dx.doi.org/10.1093/qjmed/hcq165 [10] Stone, N.J., Robinson, J., Lichtenstein, A.H., Merz, C.N., Blum, C.B., Eckel, R.H., et al. (2013) ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation, 129, S1-S45. [11] Mancini, G.B.J., Baker, S., Bergeron, J., Fitchett, D., Frohlich, J., Genest, J., Gupta, M., Hegele, R.A., Ng, D. and Pope, J. (2011) Diagnosis, Prevention, and Management of Statin Adverse Effects and Intolerance: Proceedings of a Canadian Working Group Consensus Conference. Canadian Journal of Cardiology, 27, 635-662.
http://dx.doi.org/10.1016/j.cjca.2011.05.007 [12] Law, M. and Rudnicka, A.R. (2006) Statin Safety: A Systematic Review. American Journal of Cardiology, 97, S52-S60.
http://dx.doi.org/10.1016/j.amjcard.2005.12.010 [13] JBS3 Board (2014) Joint British Societies’ Consensus Recommendations for the Prevention of Cardiovascular Disease (JBS3). Heart, 100, ii1-ii67. [14] NICE (2014) Lipid Modification: Cardiovascular Risk Assessment and the Modification of Blood Lipids for the Primary and Secondary Prevention of Cardiovascular Disease. NICE, UK. [15] Bays, H. (2005) Statin Safety: An Overview and Assessment of the Data. American Journal of Cardiology, 97, S6-S26.
http://dx.doi.org/10.1016/j.amjcard.2005.12.006 [16] Gaist, D., Rodríguez, L.A., Huerta, C., Hallas, J. and Sindrup, S.H. (2001) Lipid-Lowering Drugs and the Risk of Myopathy: A Population-Based Follow-Up Study. Epidemiology, 12, 565-569.
http://dx.doi.org/10.1097/00001648-200109000-00017 [17] Thompson, P.D., Clarkson, P.M. and Rosenson, R.S. (2006) An Assessment of Statin Safety by Muscle Experts. American Journal of Cardiology, 97, S69-S76.
http://dx.doi.org/10.1016/j.amjcard.2005.12.013 [18] Rosenson, R.S. (2004) Current Overview of Statin-Induced Myopathy. American Journal of Medicine, 116, 408-416.
http://dx.doi.org/10.1016/j.amjmed.2003.10.033 [19] Keogh, A., Macdonald, P., Kaan, A., Aboyoun, C., Spratt, P. and Mundy, J. (2000) Efficacy and Safety of Pravastatin versus Simvastatin after Cardiac Transplantation. Journal of Heart and Lung Transplantation, 19, 529-537.
http://dx.doi.org/10.1016/S1053-2498(00)00077-2 [20] Hippisley-Cox, J. (2010) Unintended Effects of Statins in Men and Women in England and Wales: Population Based Cohort Study Using the QResearch Database. BMJ, 340, c2197.
http://dx.doi.org/10.1136/bmj.c2197 [21] Carter, A.A., Gomes, T., Camacho, X., Juurlink, D.N., Shah, B.R. and Mamdani, M.M. (2013) Risk of Incident Diabetes among Patients Treated with Statins: Population Based Study. BMJ, 346, f2610.
http://dx.doi.org/10.1136/bmj.f2610 [22] Cholesterol Treatment Trialists’ (CTT) Collaboration (2010) Efficacy and Safety of More Intensive Lowering of LDL Cholesterol: A Meta-Analysis of Data from 170 000 Participants in 26 Randomised Trials. Lancet, 376, 1670-1681.
http://dx.doi.org/10.1016/S0140-6736(10)61350-5 [23] Kimberly, A.G., Monroe, A.K., Sharma, R., Ranasinghe, P.D., Chelladurai, Y. and Robinson, K.A. (2014) Effectiveness of Combination Therapy with Statin and Another Lipid-Modifying Agent Compared with Intensified Statin Monotherapy. Annals of Internal Medicine, 160, 468-476.
http://dx.doi.org/10.7326/M13-2526