Abstract 12053: Outcomes in Statin Intolerant Patients: The Cleveland Clinic Experience
Background: Intermittent statin dosing may provide beneficial lipoprotein changes and improve statin tolerance.
Objective: To determine the tolerance and efficacy of intermittent low dose statins in patients previously intolerant to statin therapy.
Methods: We performed a retrospective analysis of patients referred to the Cleveland Clinic Preventive Cardiology clinic for statin intolerance between January 1995 and March 2010. 1605 patients with at least 6 months follow-up were identified. Changes in lipid profile were analyzed. The number of patients achieving specified low-density lipoprotein cholesterol (LDL-C) goals, and tolerating different statin dosing regimens was assessed.
Results: Seventy-three percent of patients with prior statin intolerance were able to tolerate a statin for the mean follow-up time of 49 months. Overall a median LDL-C reduction of 21% was achieved with 68% of patients reaching their ATP-III goals. Although patients on intermittent statin dosing (n=149) and those discontinued from statins (n=442) had a lower reduction of LDL-C than those on daily statin dosing (n=1014), they still achieved significant LDL-C reductions from baseline (-21.3±4.0%, -8.3±2.2%, -27.7±1.4%, respectively, p<0.001) allowing significant portion of patients to achieve LDL-C goals (60%, 44%, 79%, respectively, p<0.001). When considering patients on Rosuvastatin 2.5 to 5 mg (n=372), those on intermittent dosing of less than three times a week achieved higher LDL-C reduction compared to those discontinued from statin (-12.0±6.8% for once weekly, -10.2±6.1 % for twice weekly and -8.3±2.2% for discontinued) but significantly lower than those on three or more times weekly (-16.8±7.2% for thrice weekly and -25.4±12.9% for >3 times weekly) who achieved a reduction comparable to daily dosing (-27.6±3.0%). A trend toward decrease in all-cause mortality at 8 year for patients on daily and intermittent statin dosing compared to those discontinued from statin was seen (p=0.079).
Conclusions: Prior statin intolerance does not preclude long-term statin therapy. A strategy of intermittent statin dosing in statin intolerant patients results in reduction in LDL-C, achievement of LDL-C goals and possibly reduced mortality.
- © 2011 by American Heart Association, Inc.