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Ann Intern Med. 2017 Aug 15;167(4):221-227. doi: 10.7326/M16-0838. Epub 2017 Jul 25.

Continued Statin Prescriptions After Adverse Reactions and Patient Outcomes: A Cohort Study.

Author information

1
From Peking Union Medical College Hospital, Beijing, China, and Harvard Medical School, Brigham and Women's Hospital, and Baim Institute for Clinical Research, Boston, Massachusetts.

Abstract

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.

PMID:
28738423
DOI:
10.7326/M16-0838
[Indexed for MEDLINE]

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