Abstract 17599: Medicare Beneficiaries With Indicators of Statin Intolerance Have Increased Coronary Heart Disease Risk
Introduction: Statin intolerance has been reported to occur in 5% to 20% of patients initiating therapy. There are few data on coronary heart disease (CHD) and mortality risk among patients with statin intolerance.
Hypothesis: Patients with indicators of intolerance to treatment will have higher myocardial infarction (MI), CHD-related hospitalization and all-cause mortality risk compared to those with high adherence to statins.
Methods: Using a 5% Medicare sample, we conducted a retrospective cohort study of patients with a history of CHD initiating statins between 2007 and 2011. Statin intolerance was defined as switching from statins to ezetimibe, down-titrating statins with ezetimibe initiation, ezetimibe monotherapy, having a rhabdomyolysis or antihyperlipidemic event claim followed by statin down-titration or discontinuation, statin down-titration or switching between 3 or more types of statins over the first year following statin initiation. High adherence was defined as proportion of days covered with statins ≥80% over the year following initiation using Medicare Part D claims. Patients were followed for MI, CHD-related hospitalization and mortality.
Results: Among 51,169 Medicare beneficiaries with CHD initiating statins, 21,818 (42.6%) maintained high adherence to statins and 3,978 (7.8%) met the definition for statin intolerance. Over a median of 2.1 years of follow-up, the incidence of MI for those with statin intolerance and high adherence to statins was 17.9 (95% CI 15.1-20.7) and 15.2 (95% CI 14.1-16.3) per 1,000 person-years and CHD-related hospitalization was 43.1 (95% CI 38.7-47.5) and 35.4 (95% CI 33.6-37.1), respectively. After adjustment for demographics, co-morbid conditions, and the Charlson co-morbidity score, the hazard ratio for MI comparing patients with indicators of statin intolerance to those with high statin adherence was 1.22 (95% CI: 1.02-1.45) and 1.20 (95% CI 1.07-1.35) for CHD-related hospitalization. In contrast, statin intolerance was not associated with increased mortality risk (hazard ratio 0.99; 95% CI 0.91-1.07).
Discussion: Patients with indicators of statin intolerance have an increased risk for MI and CHD-related hospitalization. Approaches are needed to reduce CHD risk in these patients.
Author Disclosures: P. Muntner: Research Grant; Significant; Amgen Inc. S.T. Kent: Other Research Support; Modest; Amgen, Inc.. L.D. Colantonio: None. R.S. Rosenson: Other Research Support; Significant; Amgen, Astra Zeneca, Sanofi. Honoraria; Significant; Kowa. Consultant/Advisory Board; Significant; Aegerion, Amgen, Astra Zeneca, Eli Lilly, GlaxoSmtihKline, Novartis, Regeneron, Sanofi. Other; Significant; Royalties: UpToDate, Inc. K.L. Monda: Employment; Significant; Amgen, Inc.. L. Huang: None. V. Bittner: Other Research Support; Significant; Amgen, Inc., Astra Zeneca, Bayer Healthcare, Janssen. Consultant/Advisory Board; Significant; Amgen, Inc. and Eli Lilly. A. Manthripragada: Employment; Significant; Amgen, Inc..
- © 2015 by American Heart Association, Inc.