Restarting statins in a specialist lipid clinic setting

Abstract

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Health Research Board. Background Statin therapy remains a gold standard in the primary and secondary prevention of cardiovascular disease (CVD).[1] Poor statin compliance and discontinuation due to statin intolerance (SI) remains a pervasive clinical issue.[1] Research has demonstrated that the prevalence of SI is overestimated with most SI symptoms being nocebo.[2-3] Our practice involves a patient centred intervention to restart statins with four components: 1) careful exclusion of differential diagnoses 2) an in-person discussion regarding SI based on contemporary evidence 3) an incremental introduction of statins starting at the lowest dose 4) virtual follow up to ensure implementation of the therapeutic plan. The aim of this study was to assess the effectiveness of this intervention in terms of statin reintroduction and subsequent cholesterol levels. Methods An ethically approved retrospective chart review was performed of consecutive adult patients attending a specialist lipid clinic over a six-month period in 2021. Patient data recorded included demographics, clinical characteristics, treatment received and biochemical profiles. Statistical analysis was performed using the Student T-test. Results This study included 370 patients. SI prevalence was 25% with 10% referred explicitly for SI. Patients with SI were predominantly female (71%). Statin-associated muscle symptoms were the most common SI (62%). Statin therapy was restarted in 48% of patients [Rosuvastatin: (62%), Simvastatin: (16%), Atorvastatin: (13%), Pravastatin: (9%)]. Restarting a statin demonstrated significantly improved mean reductions in both total cholesterol (TC) (P = 0.007) and low-density lipoprotein C (LDL-C) (P< 0.001) levels versus management with or without alternative lipid-lowering agents [primarily ezetimibe (30%)]. Statin restart: (TC mean reduction: 3.17 ± 2.27 mmol/L, LDL-C mean reduction: 2.93 ± 1.77 mmol/L). Management with or without alternative lipid-lowering agents: [TC mean reduction: 1.61 ± 1.46 mmol/L, LDL-C: 1.35 ± 0.93 mmol/L]. Conclusion This study highlights the prevalence of SI among patients attending a lipid clinic. Statins were successfully restarted in half of presenting cases and conferred significant improvement in both TC and LDL-C levels compared to management with or without alternative lipid-lowering agents. Interventions for SI are warranted given the high prevalence of nocebo effect and the undoubted benefits of statin treatment. Ideally such interventions should be replicated in a primary care setting.