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Differential Effects of Lipid-lowering Drugs in Modulating Morphology of Cholesterol Particles
Published on: November 10, 2017
Continued Statin Prescriptions After Adverse Reactions and Patient Outcomes: A Cohort Study
Huabing Zhang1, Jorge Plutzky1, Maria Shubina1
1From Peking Union Medical College Hospital, Beijing, China, and Harvard Medical School, Brigham and Women's Hospital, and Baim Institute for Clinical Research, Boston, Massachusetts.
Background:
Many patients discontinue statin treatment, often after having a possible adverse reaction. The risks and benefits of continued statin therapy after an adverse reaction are not known.
Objective:
To examine the relationship between continuation of statin therapy (any prescription within 12 months after an adverse reaction) and clinical outcomes.
Design:
Retrospective cohort study.
Setting:
Primary care practices affiliated with 2 academic medical centers.
Participants:
Patients with a presumed adverse reaction to a statin between 2000 and 2011.
Measurements:
Information on adverse reactions to statins was obtained from structured electronic medical record data or natural-language processing of narrative provider notes. The primary composite outcome was time to a cardiovascular event (myocardial infarction or stroke) or death.
Results:
Most (81%) of the adverse reactions to statins were identified from the text of electronic provider notes. Among 28 266 study patients, 19 989 (70.7%) continued receiving statin prescriptions after the adverse reaction. Four years after the presumed adverse event, the cumulative incidence of the composite primary outcome was 12.2% for patients with continued statin prescriptions, compared with 13.9% for those without them (difference, 1.7% [95% CI, 0.8% to 2.7%]; P < 0.001). In a secondary analysis of 7604 patients for whom a different statin was prescribed after the adverse reaction, 2014 (26.5%) had a documented adverse reaction to the second statin, but 1696 (84.2%) of those patients continued receiving statin prescriptions.
Limitations:
The risk for recurrent adverse reactions to statins could not be established for the entire sample. It was also not possible to determine whether patients actually took the statins.
Conclusion:
Continued statin prescriptions after an adverse reaction were associated with a lower incidence of death and cardiovascular events.
Primary Funding Source:
Chinese National Key Program of Clinical Science, National Natural Science Foundation of China, and Young Scientific Research Fund of Peking Union Medical College Hospital.
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