Abstract 17200: Alternate Statin Protocol: A Novel Nurse Practitioner Managed Approach for Treating Women with Previous Statin Intolerance
Background: HMG-CoA reductase inhibitors (statins) are efficacious in treating coronary artery disease (CAD). Adherence is problematic due to side effects which prevent high risk patients from receiving optimal benefit from statin therapy. Despite the prevalence of this problem, the tolerability and effectiveness of alternate dosing in statin therapy has not been evaluated clinically. The aim of this study was to evaluate the effectiveness of a nurse practitioner (NP) alternate statin dosing protocol to increase adherence, tolerance, and reduction of lipid levels.
Methods: At a tertiary chest pain center, we analyzed 15 women who tolerated alternate dosing who had prior statin intolerance, defined as the inability to tolerate daily dosing. An NP protocol was used for initiation and maintenance of alternate dosing. Women with prior statin intolerance were placed on atorvastatin, pravastatin, rosuvastatin or simvastatin for the reduction of total cholesterol (TC) and low-density lipoprotein (LDL-C). Patients were initially started on twice weekly statin dosing on Mondays and Thursdays for 4 weeks then titrated up one day per week as tolerated. Fasting baseline and follow-up lipid levels were obtained by chart review. Wilcoxon signed rank test was performed on the data.
Results: We evaluated 15 female patients with a mean age of 62 ± 14 years and a BMI of 26 ± 5. Overall, 60% had CAD, 60% had hypertension, 7% had diabetes, and 47% had a history of smoking. Prior to initiating the alternate dosing NP protocol 93% were intolerant to 2 or more statins with myalgias. Utilizing the alternate dosing NP protocol, we observed a mean 32% reduction in LDL 84 ± 39 mg/dl compared to their prior highest LDL level 134 ± 49 mg/dl (p<0.001). We also observed a 20% statistically significant reduction of TC after initiation of the alternate dosing NP protocol (p<0.0001).
Conclusions: In a group of women who tolerated alternate dosing, utilizing an NP alternate dosing protocol increases tolerability and is effective in reducing TC and LDL-C levels. Further studies are warranted in larger populations in an effort to increase adherence in women who are labeled statin intolerant.
- © 2010 by American Heart Association, Inc.