The Impact of Statin Intolerance in Lipid Clinic Patients

Kate Williams,Vinita Mishra

doi:10.4236/ijcm.2015.65040

Kate Williams, Vinita Mishra

Open Access

https://doi.org/10.4236/ijcm.2015.65040

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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.

Highlights

Cardiovascular disease is associated with significant mortality and morbidity worldwide; it is the most prevalent medical condition in Western societies [1]
The alternative lipid lowering therapy, which was either alternative low dose statin only, combination of statin with non-statin lipid modifying medication or only non-statin therapy was initiated in patients after they presented with statin intolerance
Intolerance to Rosuvastatin 13 female, 6 male, average age 58.5 years. 1 patient diagnosed with familial hypercholesterolemia, 6 patients were with secondary prevention and 12 patients were on rosuvastatin for primary prevention

Summary

Introduction

Cardiovascular disease is associated with significant mortality and morbidity worldwide; it is the most prevalent medical condition in Western societies [1]. Multiple risk factors, including hypertension, diabetes mellitus, dyslipidaemia, sedentary lifestyle, smoking and stress potentiate cardiovascular morbidity [2]. Management of hypercholesterolemia includes lifestyle changes such as smoking cessation, healthy diet, weight loss and regular exercise [3]; alongside which pharmacological intervention may be required. Statins are the most commonly and successfully used drugs for lowering serum total cholesterol [4], and have been shown to be effective in primary prevention (no previous cardiovascular events), secondary prevention (previous cardiovascular event) and familial hypercholesterolemia [4] [5]. Use of statins produces significant reduction in cardiovascular morbidity and overall mortality in primary and secondary prevention populations [6]

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