Discontinuation of statins in routine care settings: a cohort study

Abstract

Background: Systematic data on discontinuation of statins in routine practice of medicine are limited.

Objective: To investigate the reasons for statin discontinuation and the role of statin-related events (clinical events or symptoms believed to have been caused by statins) in routine care settings.

Design: A retrospective cohort study.

Setting: Practices affiliated with Brigham and Women's Hospital and Massachusetts General Hospital in Boston.

Patients: Adults who received a statin prescription between 1 January 2000 and 31 December 2008.

Measurements: Information on reasons for statin discontinuations was obtained from a combination of structured electronic medical record entries and analysis of electronic provider notes by validated software.

Results: Statins were discontinued at least temporarily for 57 292 of 107 835 patients. Statin-related events were documented for 18 778 (17.4%) patients. Of these, 11 124 had statins discontinued at least temporarily; 6579 were rechallenged with a statin over the subsequent 12 months. Most patients who were rechallenged (92.2%) were still taking a statin 12 months after the statin-related event. Among the 2721 patients who were rechallenged with the same statin to which they had a statin-related event, 1295 were receiving the same statin 12 months later, and 996 of them were receiving the same or a higher dose.

Limitations: Statin discontinuations and statin-related events were assessed in practices affiliated with 2 academic medical centers. Utilization of secondary data could have led to missing or misinterpreted data. Natural-language-processing tools used to compensate for the low (30%) proportion of reasons for statin discontinuation documented in structured electronic medical record fields are not perfectly accurate.

Conclusion: Statin-related events are commonly reported and often lead to statin discontinuation. However, most patients who are rechallenged can tolerate statins long-term. This suggests that many of the statin-related events may have other causes, are tolerable, or may be specific to individual statins rather than the entire drug class.

Primary funding source: National Library of Medicine, Diabetes Action Research and Education Foundation, and Chinese National Key Program of Clinical Science.

Figures

Figure 1

Selection of Study Patients. Abbreviations: BWH, Brigham and Women's Hospital; MGH, Massachusetts General Hospital.

Figure 2

Statin Discontinuation by patients with statin-related events.

Figure 3

Statin discontinuation by patients with no statin-related events