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Kraut R, Wierenga F, Molstad E, Korownyk C, Perry D, Dennett L, Garrison S. Intolerance upon statin rechallenge: A systematic review and meta-analysis of randomized controlled trials. PLoS One 2023; 18:e0295857. [PMID: 38128013 PMCID: PMC10735036 DOI: 10.1371/journal.pone.0295857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 11/30/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Although statins are often discontinued when myalgia arises, a causal relationship may not always exist. How well-tolerated statins are when rechallenge is blinded and controlled is unclear. METHODS AND FINDINGS We performed a systematic review and meta-analysis (PROSPERO CRD42023437648) to evaluate the success of statin rechallenge versus matched placebo in those who were previously statin intolerant. Our primary outcome was intolerance; our secondary outcome was the myalgia or global symptom score. Medline, Embase, CINAHL Plus, Scopus, and CENTRAL were searched from inception to May 1, 2023. Eligible trials were randomized controlled trials with parallel or crossover designs examining statin rechallenge in statin-intolerant adults. Two independent reviewers selected studies, extracted data, and assessed risk of bias (Cochrane Collaboration's risk-of-bias tool 1). Relative risk (RR) and mean difference (MD) were estimated using fixed effect Mantel-Haenszel statistics. Of 1,941 studies screened, 8 met our inclusion criteria (8 to 491 participants from Asia, Europe, North America, and Oceana). Compared to placebo, intolerance was more common in statin users [325/906 (36%) vs 233/911 (26%), RR 1.40, 95% CI, 1.23 to 1.60, I2 = 0%, 7 trials, number needed to harm 10] and there was no statistically significant difference in myalgia or global symptom score on a 100-point scale [MD 1.08, 95% CI, -1.51 to 3.67, I2 = 0%, 5 trials]. Limitations include only 1 trial asking participants about intolerable symptoms (vs inferring intolerance from discontinuation or trial withdrawal); the small number of trials; the possibility of attrition bias; and the potential for carryover effects in crossover/n-of-1 trial designs. CONCLUSIONS Of those previously intolerant of statins who were rechallenged with a statin and compared to placebo recipients, medication intolerance was more common amongst statin recipients. However, there was no significant difference in mean myalgia or global symptom score between statin and placebo, and only one-third of those previously believed to be statin intolerant were unable to tolerate a statin on blinded rechallenge; one-quarter were intolerant of placebo.
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Affiliation(s)
- Roni Kraut
- Department of Family Medicine, University of Alberta, Edmonton, Canada
| | - Faith Wierenga
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Elisa Molstad
- Faculty of Science, University of Alberta, Edmonton, Canada
| | | | - Danielle Perry
- Department of Family Medicine, University of Alberta, Edmonton, Canada
- College of Family Physicians of Canada, Mississauga, Ontario, Canada
| | - Liz Dennett
- Sperber Health Sciences Library, University of Alberta, Edmonton, Canada
| | - Scott Garrison
- Department of Family Medicine, University of Alberta, Edmonton, Canada
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Louro R, Gouveia E Melo R, Ruivo J, Almeida AG, Pinto FJ, Caldeira D. Incidence of muscle symptoms in placebo arm among statin-intolerant patients: a systematic review with meta-analysis. Expert Rev Cardiovasc Ther 2023; 21:887-894. [PMID: 37916684 DOI: 10.1080/14779072.2023.2274502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 10/19/2023] [Indexed: 11/03/2023]
Abstract
INTRODUCTION Statins are highly used in cardiovascular prevention. Statin intolerance is the most significant cause of decreased adherence, translating into a higher cardiovascular risk. This systematic review aims to estimate the incidence of muscle adverse events in patients with a history of statin intolerance receiving placebo. METHODS Database search was performed in CENTRAL, MEDLINE, and EMBASE until March 2023. This systematic review included blinded randomized control trials enrolling patients with a history of statin intolerance who received a placebo. A random-effects meta-analysis was performed. Results were presented in percentages, with 95% confidence intervals (95% CI). RESULTS Overall, eight studies with 8095 patients with a history of statin intolerance receiving placebo were included. The muscle adverse events incidence rate was 21.34% (95% CI 13.26-30.63%, 8 studies), and discontinuation due to adverse muscle events was 6.12% (95% CI 1.22-13.70%, 3 studies). The incidence was higher in subcutaneous placebo/sham (41.67%, 1 study) compared to oral placebo studies (22.95%, 6 studies). CONCLUSION In patients previously labeled as statin-intolerant, about a fifth of the patients exhibited muscle symptoms when receiving a placebo. This highlights the importance of ruling out non-statin-related symptoms to further optimize statin therapy for cardiovascular risk improvement.
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Affiliation(s)
- Rita Louro
- Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Ryan Gouveia E Melo
- Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
- Vascular Surgery, Heart and Vessels Department, Hospital Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
- Cardiovascular da Universidade de Lisboa - CCUL (CCUL@RISE), Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Jorge Ruivo
- Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
- Cardiovascular da Universidade de Lisboa - CCUL (CCUL@RISE), Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Ana G Almeida
- Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
- Cardiovascular da Universidade de Lisboa - CCUL (CCUL@RISE), Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
- Cardiology Department, Hospital Universitário de Santa Maria (CHLN), Centro Académico de Medicina de Lisboa (CAML), Lisbon, Portugal
| | - Fausto J Pinto
- Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
- Cardiovascular da Universidade de Lisboa - CCUL (CCUL@RISE), Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
- Cardiology Department, Hospital Universitário de Santa Maria (CHLN), Centro Académico de Medicina de Lisboa (CAML), Lisbon, Portugal
| | - Daniel Caldeira
- Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
- Cardiovascular da Universidade de Lisboa - CCUL (CCUL@RISE), Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
- Cardiology Department, Hospital Universitário de Santa Maria (CHLN), Centro Académico de Medicina de Lisboa (CAML), Lisbon, Portugal
- Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
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Wijekoon N, Wijekoon S, Bulugahapitiya U, Pathirana N, Wickramasinghe M, Paranavitane S, Kottage A, Wijayawardena S, Karunarathne M, Samarasinghe M, Sumanadasa S, Herath Y. Tolerability and effectiveness of every-other-day atorvastatin compared to daily atorvastatin in patients with muscle symptoms: A randomized controlled clinical trial. Contemp Clin Trials Commun 2020; 20:100685. [PMID: 33319120 PMCID: PMC7726662 DOI: 10.1016/j.conctc.2020.100685] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 11/01/2020] [Accepted: 12/01/2020] [Indexed: 01/31/2023] Open
Abstract
Despite limited evidence, non-daily dosing of statins is recommended for managing muscle symptoms associated with statin therapy. We assessed the tolerability and effectiveness of every-other-day atorvastatin compared to daily atorvastatin in patients having muscle symptoms associated with atorvastatin therapy. A parallel-group, outcome-assessment-blinded, randomized controlled clinical trial was conducted at Colombo South Teaching Hospital, Sri Lanka. Patients with muscle pain, tenderness or cramps alone or in combination for ≥2 weeks while on daily atorvastatin for ≥1 month, with no alternative cause, were recruited. Patient's regular atorvastatin dose was given every-other-day to those in intervention group (IG) and daily to those in control group (CG). Primary outcomes were assessed at 24 weeks and included composite of myalgia and myositis, LDL-cholesterol level and percentage reduction of LDL-cholesterol from baseline. Number recruited was 49 to IG (women:79.6%; mean-age:60.6 ± 8.7years) and 52 to CG (women:73.1%; mean-age:61.7 ± 9.8years). Mean atorvastatin dose per day was 8.6 mg (SD = 4 mg) and 17.6 mg (SD = 8.4 mg) in IG and CG, respectively. Composite of myalgia and myositis at 24 weeks was 79.6% in IG and 69.2% in CG (OR = 1.7, 95% CI 0.7-4.3; p = 0.234). IG failed to show noninferiority for mean LDL-cholesterol (difference:0.31 mmol/L; upper limit 97.5% CI:0.61 mmol/L; p for noninferiority = 0.989) and for mean percentage reduction of LDL-cholesterol from baseline (difference:3.13%; upper limit 97.5% CI:15.5%; p for noninferiority = 0.718). At 24 weeks, mean creatine kinase and discomfort due to muscle symptoms (assessed with Visual Analogue Scale) were not different between the two groups. Findings of this study do not favor every-other-day atorvastatin as an option for managing patients with muscle symptoms associated with atorvastatin therapy.
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Affiliation(s)
- Nirmala Wijekoon
- Department of Pharmacology, Faculty of Medical Sciences, University of Sri Jayewardenepura, Gangodawila, Nugegoda, Sri Lanka
| | - Sanjeewa Wijekoon
- Department of Medicine, Faculty of Medical Sciences, University of Sri Jayewardenepura, Gangodawila, Nugegoda, Sri Lanka.,Colombo South Teaching Hospital, Kalubowila, Sri Lanka
| | | | - Nethrani Pathirana
- Department of Medicine, Faculty of Medical Sciences, University of Sri Jayewardenepura, Gangodawila, Nugegoda, Sri Lanka
| | - Malintha Wickramasinghe
- Department of Medicine, Faculty of Medical Sciences, University of Sri Jayewardenepura, Gangodawila, Nugegoda, Sri Lanka
| | | | | | - Supun Wijayawardena
- Department of Medicine, Faculty of Medical Sciences, University of Sri Jayewardenepura, Gangodawila, Nugegoda, Sri Lanka
| | - Mihipali Karunarathne
- Department of Medicine, Faculty of Medical Sciences, University of Sri Jayewardenepura, Gangodawila, Nugegoda, Sri Lanka
| | - Madusha Samarasinghe
- Department of Medicine, Faculty of Medical Sciences, University of Sri Jayewardenepura, Gangodawila, Nugegoda, Sri Lanka
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Brandts J, Ray KK. Bempedoic acid, an inhibitor of ATP citrate lyase for the treatment of hypercholesterolemia: early indications and potential. Expert Opin Investig Drugs 2020; 29:763-770. [DOI: 10.1080/13543784.2020.1778668] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Julia Brandts
- Department of Medicine I, University Hospital RWTH Aachen , Aachen, Germany
- Imperial Centre for Cardiovascular Disease Prevention, School of Public Health, Imperial College London , London, UK
| | - Kausik K. Ray
- Imperial Centre for Cardiovascular Disease Prevention, School of Public Health, Imperial College London , London, UK
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Sivashanmugarajah A, Fulcher J, Sullivan D, Elam M, Jenkins A, Keech A. Suggested clinical approach for the diagnosis and management of ‘statin intolerance’ with an emphasis on muscle‐related side‐effects. Intern Med J 2019; 49:1081-1091. [DOI: 10.1111/imj.14429] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 05/24/2019] [Accepted: 06/07/2019] [Indexed: 12/25/2022]
Affiliation(s)
- Anosh Sivashanmugarajah
- National Health and Medical Research Council (NHMRC) Clinical Trials CentreUniversity of Sydney Sydney New South Wales Australia
- Department of CardiologyRoyal Prince Alfred Hospital Sydney New South Wales Australia
| | - Jordan Fulcher
- National Health and Medical Research Council (NHMRC) Clinical Trials CentreUniversity of Sydney Sydney New South Wales Australia
- Department of CardiologyRoyal Prince Alfred Hospital Sydney New South Wales Australia
| | - David Sullivan
- NSW Health PathologyRoyal Prince Alfred Hospital Sydney New South Wales Australia
| | - Marshall Elam
- Department of Pharmacology, University of Tennessee Knoxville Tennessee USA
| | - Alicia Jenkins
- National Health and Medical Research Council (NHMRC) Clinical Trials CentreUniversity of Sydney Sydney New South Wales Australia
- Department of MedicineUniversity of Melbourne, St. Vincent's Hospital Melbourne Victoria Australia
| | - Anthony Keech
- National Health and Medical Research Council (NHMRC) Clinical Trials CentreUniversity of Sydney Sydney New South Wales Australia
- Department of CardiologyRoyal Prince Alfred Hospital Sydney New South Wales Australia
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Park C, Le Q. Efficacy and Tolerability of non-daily Statin Administration: A Systematic Review of Literature. JOURNAL OF CONTEMPORARY PHARMACY PRACTICE 2019. [DOI: 10.37901/jcphp18-00003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Cindy Park
- Western University of Health Sciences, College of Pharmacy
| | - Quang Le
- Western University of Health Sciences, College of Pharmacy
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Irwin JC, Khalesi S, Fenning AS, Vella RK. The effect of lipophilicity and dose on the frequency of statin-associated muscle symptoms: A systematic review and meta-analysis. Pharmacol Res 2018; 128:264-273. [DOI: 10.1016/j.phrs.2017.09.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 09/19/2017] [Accepted: 09/20/2017] [Indexed: 10/18/2022]
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Keating AJ, Campbell KB, Guyton JR. Intermittent Nondaily Dosing Strategies in Patients with Previous Statin-Induced Myopathy. Ann Pharmacother 2016; 47:398-404. [DOI: 10.1345/aph.1r509] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To review the safety and efficacy of alternative intermittent statin dosing regimens in patients with previous intolerance due to myopathy. DATA SOURCES Literature was accessed through MEDLINE (1946 -December 2012) and EMBASE (1966-December 2012) using relevant MeSH and Emtree search terms, including statins, HMG Co-A reductase inhibitors, simvastatin, atorvastatin, lovastatin, fluvastatin, pravastatin, pitavastatin, rosuvastatin, myopathy, and myalgias. Web of Science (1955-December 2012) and the aforementioned databases were additionally searched using combinations of the following text words: statin intolerance, alternate dosing, nondaily dosing, weekly dosing, statin-induced myopathy, and intermittent statin dosing. References of identified articles were reviewed for additional citations. STUDY SELECTION AND DATA EXTRACTION All identified English-language peer-reviewed publications were evaluated. Articles (excluding meeting abstracts) specifically addressing nondaily statin use in patients with previous statin-induced myopathy were reviewed. DATA SYNTHESIS Although statins have achieved significant reductions in cardiovascular morbidity and mortality, as many as 10% of patients prescribed these therapies experience myopathies. Intermittent statin regimens ranging from every-other-day to once- weekly dosing have emerged in an attempt to maintain efficacy while moderating the incidence of adverse effects. The results reported in 10 publications investigating varying regimens with atorvastatin and/or rosuvastatin revealed that at least 70% of patients were able to tolerate an intermittent dosing strategy without a recurrence of previous treatment-limiting adverse effects. Although the degree of low-density lipoprotein cholesterol–lowering varied appreciably among studies (12–38%), the addition of a nondaily statin regimen facilitated attainment of National Cholesterol Education Program goals for some. CONCLUSIONS Although areas of uncertainty remain, intermittent dosing (particularly with rosuvastatin and atorvastatin) in previously intolerant patients is a useful strategy to capitalize on the benefits of this therapy. Larger scale randomized trials are necessary to more clearly define the role of this strategy and the optimal choice of regimen.
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Affiliation(s)
- Alyssa J Keating
- Alyssa J Keating PharmD BCPS, PGY2 Cardiology Pharmacy Resident, Duke University Hospital, Durham, NC
| | - Kristen Bova Campbell
- Kristen Bova Campbell PharmD CPP BCPS (AQ Cardiology), Clinical Pharmacist, Cardiology, Duke University Hospital; PGY2 Cardiology Residency Program Director
| | - John R Guyton
- John R Guyton MD, Associate Professor of Medicine, Department of Medicine, Duke University Medical Center, Durham
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Cicero AFG, Morbini M, Bove M, D'Addato S, Fogacci F, Rosticci M, Borghi C. Additional therapy for cholesterol lowering in ezetimibe-treated, statin-intolerant patients in clinical practice: results from an internal audit of a university lipid clinic. Curr Med Res Opin 2016; 32:1633-1638. [PMID: 27175514 DOI: 10.1080/03007995.2016.1190326] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE The aim of our study was to evaluate the tolerability and efficacy of alternative approaches to improve cholesterolemia control in patients with statin-related myalgia treated with ezetimibe. RESEARCH DESIGN AND METHODS We retrospectively evaluated 3534 Clinical Report Forms (CRFs) filled in the period June 2012-June 2015 for first visits to the lipid clinic of the University of Bologna. For this study, we selected 252 CRFs based on the following criteria: statin-related myalgia, previous failed treatment with at least two low-dosed statins, well tolerated treatment with ezetimibe. Then, the following lipid-lowering treatments were added in order to improve the ezetimibe low density lipoprotein cholesterol (LDL-C) lowering efficacy, based on clinical judgment: fenofibrate 145 mg, rosuvastatin 5 mg 1 tablet/week, rosuvastatin 5 mg 2 tablets/week, red yeast rice (standardized in monacolin K 3 mg) + berberine 500 mg, berberine 500 mg b.i.d., phytosterols 900 mg + psyllium fiber 3.5 g b.i.d. Patients continuing to claim a tolerable myalgia were then treated with coenzyme Q10 nanoemulsions 200 mg/day. RESULTS The treatment with standard lipid-lowering diet plus ezetimibe alone was associated with a mean LDL-C reduction of 17 ± 2%. The additive LDL-lowering effect with the various tested treatment was: -16 ± 2% with fenofibrate 145 mg/day, -13 ± 1% with rosuvastatin 5 mg 1 tablet/week, -17 ± 3% with rosuvastatin 5 mg 2 tablets/week, -19 ± 4% with red yeast rice + berberine, -17 ± 4% with berberine b.i.d. and -10 ± 3% with phytosterols + psyllium b.i.d.; 11% of the patients treated with fenofibrate required treatment modification because of myalgia recurrence, while the percentage was negligible for the other tested treatments. In patients with residual tolerable myalgia, treatment with coenzyme Q10 for 8 weeks was associated with a mean improvement of the graduated myalgia score from 4.8 ± 1.9 to 2.9 ± 1.3 (p = 0.013). CONCLUSIONS Some alternative treatments seems to be effective and well tolerated, thus improving the ezetimibe effect on cholesterolemia.
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Affiliation(s)
- Arrigo F G Cicero
- a S. Orsola-Malpighi University Hospital, Lipid Clinic , Bologna , Italy
| | - Martino Morbini
- a S. Orsola-Malpighi University Hospital, Lipid Clinic , Bologna , Italy
| | - Marilisa Bove
- a S. Orsola-Malpighi University Hospital, Lipid Clinic , Bologna , Italy
| | - Sergio D'Addato
- a S. Orsola-Malpighi University Hospital, Lipid Clinic , Bologna , Italy
| | - Federica Fogacci
- a S. Orsola-Malpighi University Hospital, Lipid Clinic , Bologna , Italy
| | - Martina Rosticci
- a S. Orsola-Malpighi University Hospital, Lipid Clinic , Bologna , Italy
| | - Claudio Borghi
- a S. Orsola-Malpighi University Hospital, Lipid Clinic , Bologna , Italy
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Algharably EAH, Filler I, Rosenfeld S, Grabowski K, Kreutz R. Statin intolerance - a question of definition. Expert Opin Drug Saf 2016; 16:55-63. [PMID: 27645111 DOI: 10.1080/14740338.2017.1238898] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Statin therapy is the backbone of pharmacologic therapy for low-density lipoproteins cholesterol lowering and plays a pivotal role in cardiovascular disease prevention. Statin intolerance is understood as the inability to continue using a statin to reduce individual cardiovascular risk sufficiently, due to the development of symptoms or laboratory abnormalities attributable to the initiation or dose escalation of a statin. Muscle symptoms are the most common side effects observed. Areas covered: The main aim of this article is to present a review on published definitions of statin intolerance. In addition, a brief review on clinical aspects and risk factors of statin intolerance is provided and features for a common definition for statin intolerance are suggested. Expert opinion: A definition of statin intolerance by major drug regulatory agencies is not available. In clinical studies, different definitions are chosen and results are not comparable; different medical associations do not agree on one common definition. There is an unmet need to establish a common definition of statin intolerance to ensure an appropriate clinical use of this important drug class. Further work is required to develop a consensus definition on statin intolerance that could have significant positive impact on both research and clinical management.
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Affiliation(s)
- Engi Abdel-Hady Algharably
- a Institut für Klinische Pharmakologie und Toxikologie , Charité - Universitätsmedizin Berlin , Berlin , Germany.,b Department of Clinical Pharmacy, Faculty of Pharmacy , Ain Shams University , Cairo , Egypt
| | - Iris Filler
- a Institut für Klinische Pharmakologie und Toxikologie , Charité - Universitätsmedizin Berlin , Berlin , Germany
| | - Stephanie Rosenfeld
- c Sanofi-Aventis Deutschland GmbH , Evidence Based Medicine , Berlin , Germany
| | - Katja Grabowski
- a Institut für Klinische Pharmakologie und Toxikologie , Charité - Universitätsmedizin Berlin , Berlin , Germany
| | - Reinhold Kreutz
- a Institut für Klinische Pharmakologie und Toxikologie , Charité - Universitätsmedizin Berlin , Berlin , Germany
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Joy TR, Brennan ET. Management strategies in patients with statin-associated muscle symptoms: What is the best strategy? J Clin Lipidol 2016; 10:1067-72. [DOI: 10.1016/j.jacl.2016.06.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Revised: 06/07/2016] [Accepted: 06/15/2016] [Indexed: 10/21/2022]
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Patel J, Martin SS, Banach M. Expert opinion: the therapeutic challenges faced by statin intolerance. Expert Opin Pharmacother 2016; 17:1497-507. [DOI: 10.1080/14656566.2016.1197202] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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14
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Rosuvastatin: Beyond the cholesterol-lowering effect. Pharmacol Res 2016; 107:1-18. [PMID: 26930419 DOI: 10.1016/j.phrs.2016.02.012] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Revised: 02/13/2016] [Accepted: 02/14/2016] [Indexed: 12/18/2022]
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Cornier MA, Eckel RH. Non-traditional dosing of statins in statin-intolerant patients-is it worth a try? Curr Atheroscler Rep 2015; 17:475. [PMID: 25432858 DOI: 10.1007/s11883-014-0475-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
In this manuscript, three manifestations of statin intolerance will be covered. The first, myopathy, is mostly subjective with variable complaints of myalgias often worsened by exercise, muscle cramping or weakness, and at times associated with a biomarker, elevations in creatine kinase (CK). A rare but serious manifestation can be rhabdomyolysis. The second, liver toxicity, is associated with reversible biochemical increases in transaminases and rarely other liver function tests. Finally, statin-related central nervous system (CNS) toxicity typically defined as cognitive impairment is quite rare and appears to be idiosyncratic. Statin dose alternatives will then be discussed and highlighted in the setting of the new cholesterol-lowering guidelines. Non-statin lipid-altering therapies as well as other alternative therapies will also be reviewed.
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Affiliation(s)
- Marc-Andre Cornier
- Division of Endocrinology, Metabolism and Diabetes, University of Colorado School of Medicine, Mail Stop C26, 12348 E Montview Blvd, Aurora, CO, 80045, USA,
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Bangalore S, Breazna A, DeMicco DA, Wun CC, Messerli FH. Visit-to-visit low-density lipoprotein cholesterol variability and risk of cardiovascular outcomes: insights from the TNT trial. J Am Coll Cardiol 2015; 65:1539-48. [PMID: 25881936 DOI: 10.1016/j.jacc.2015.02.017] [Citation(s) in RCA: 140] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Revised: 01/24/2015] [Accepted: 02/03/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Studies demonstrate that lowering low-density lipoprotein cholesterol (LDL-C) using a statin is associated with significant reduction in cardiovascular events. Whether visit-to-visit variability in LDL-C levels affects cardiovascular outcomes is unknown. OBJECTIVES This study sought to evaluate the role of visit-to-visit variability in LDL-C levels on cardiovascular outcomes. METHODS We evaluated patients with coronary artery disease and LDL-C <130 mg/dl enrolled in the TNT (Treating to New Targets) trial, randomly assigned to receive atorvastatin 80 mg/day versus 10 mg/day and with at least one post-baseline measurement of LDL-C. Visit-to-visit LDL-C variability was evaluated from 3 months into random assignment through the use of various measurements of LDL-C variability: SD, average successive variability (ASV), coefficient of variation, and variation independent of mean, with the first 2 measurements used as the primary measurements. Primary outcome was any coronary event, and secondary outcomes were any cardiovascular event, death, myocardial infarction, or stroke. RESULTS Among 9,572 patients, SD and ASV were significantly lower with atorvastatin 80 mg/day versus 10 mg/day (SD: 12.03 ± 9.70 vs. 12.52 ± 7.43; p = 0.005; ASV: 12.84 ± 10.48 vs. 13.76 ± 8.69; p < 0.0001). In the adjusted model, each 1-SD increase in LDL-C variability (by ASV) increased the risk of any coronary event by 16% (hazard ratio [HR]: 1.16; 95% confidence interval [CI]: 1.10 to 1.23; p < 0.0001), any cardiovascular event by 11% (HR: 1.11; 95% CI: 1.07 to 1.15; p < 0.0001), death by 23% (HR: 1.23; 95% CI: 1.14 to 1.34; p < 0.0001), myocardial infarction by 10% (HR: 1.10; 95% CI: 1.02 to 1.19; p = 0.02), and stroke by 17% (HR: 1.17; 95% CI: 1.04 to 1.31; p = 0.01), independent of treatment effect and achieved LDL-C levels. Results were largely consistent when adjusted for medication adherence. CONCLUSIONS In subjects with coronary artery disease, visit-to-visit LDL-C variability is an independent predictor of cardiovascular events.
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Affiliation(s)
- Sripal Bangalore
- Division of Cardiology, New York University School of Medicine, New York, New York.
| | | | | | | | - Franz H Messerli
- Division of Cardiology, St. Luke's-Roosevelt Hospital, Mount Sinai School of Medicine, New York, New York
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Agouridis AP, Nair DR, Mikhailidis DP. Strategies to overcome statin intolerance. Expert Opin Drug Metab Toxicol 2015; 11:851-5. [DOI: 10.1517/17425255.2015.1027685] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Moriarty PM, Jacobson TA, Bruckert E, Thompson PD, Guyton JR, Baccara-Dinet MT, Gipe D. Efficacy and safety of alirocumab, a monoclonal antibody to PCSK9, in statin-intolerant patients: Design and rationale of ODYSSEY ALTERNATIVE, a randomized phase 3 trial. J Clin Lipidol 2014; 8:554-561. [DOI: 10.1016/j.jacl.2014.09.007] [Citation(s) in RCA: 108] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Revised: 09/10/2014] [Accepted: 09/15/2014] [Indexed: 11/24/2022]
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Auer J, Sinzinger H, Franklin B, Berent R. Muscle- and skeletal-related side-effects of statins: tip of the iceberg? Eur J Prev Cardiol 2014; 23:88-110. [DOI: 10.1177/2047487314550804] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Accepted: 08/18/2014] [Indexed: 11/15/2022]
Affiliation(s)
- Johann Auer
- Department of Cardiology and Intensive Care, General Hospital Braunau, Braunau, Austria
| | - Helmut Sinzinger
- Department of Nuclear Medicine, Medical University, Vienna, Austria
| | - Barry Franklin
- Cardiac Rehabilitation and Exercise Laboratories, William Beaumont Hospital Royal Oak, MI, USA
| | - Robert Berent
- Center of Cardiac Rehabilitation, Bad Ischl, Austria
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Abstract
Background Non-adherence is a major obstacle with long-term daily statin therapy. Objective This retrospective study reviewed the medical records of patients with hyperlipidemia during an 8-year period in a private internal medicine practice. Periodic dosing was negotiated following several patients’ refusal of statin therapy because of muscle aches or cost. Methods The clinical impetus was patient adherence to statin therapy. Treatment was initiated by dispensing rosuvastatin or atorvastatin in a stepwise patient-directed approach (from two times/week to three times/week to every other day, up to five times/week). The primary endpoint was to assess the concentration of low-density lipoprotein cholesterol (LDL-C) and the total cholesterol/high-density lipoprotein cholesterol (TC/HDL-C) ratio with patient-directed dosing intervals. The secondary endpoint was a head-to-head comparison of atorvastatin and rosuvastatin to evaluate the mean decrease in the LDL-C and TC/HDL-C ratio. Results Chart review identified 46 patients who had been treated. Two patients with persistent myalgia terminated treatment before 12 weeks. Among the remaining 44 patients, 20 received doses of rosuvastatin from 15 to 100 mg per week, and 24 received atorvastatin from 20 to 140 mg per week. There was a significant decrease from pre-treatment in the mean TC/HDL-C ratio of 1.72 (31.1 %, P < 0.0001) and mean LDL-C of 43.3 mg/dL (30.2 %, P < 0.0001). An independent samples t-test showed a non-significant reduction of the mean TC/HDL-C ratio and LDL-C with rosuvastatin versus atorvastatin. Conclusion Periodic dosing of rosuvastatin or atorvastatin using a gradual, patient-directed, stepwise approach guided by cholesterol levels is an effective method of lipid lowering and carried a favorable 95.6 % adherence rate.
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Naderi S, Cho L. Statin intolerance: diagnosis, treatment and alternative therapies. ACTA ACUST UNITED AC 2014. [DOI: 10.2217/clp.14.23] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Abstract
The term statin intolerance refers to an inability to use statins because of muscle symptoms or elevated creatine kinase, and the major diagnostic challenge is to unambiguously link these to statin use. Roughly 5% to 10% of statin users develop statin intolerance, and because statin use is expected to increase--especially after recent updated guidelines have expanded the statin benefit groups--adverse effects from statins will become a growing issue. Unfortunately, the pathophysiology--and even the terminology--of statin-related muscle injury lacks clarity. Several risk factors have been identified, including advanced age, family history of myopathy and statin dose; many cases manifest only after patients are administered an interacting medication (e.g., azole antifungals, cimetidine, clarithromycin, erythromycin and cyclosporine). The diagnosis of myopathy remains challenging, especially because some patients can have normal serum creatine kinase levels despite demonstrable weakness and muscle biopsy-proven statin-induced myopathy. A statin withdrawal and rechallenge helps patients distinguish whether their myalgia symptoms are because of statins, but, in at least 1 clinical trial, even 5% of placebo-treated patients developed myalgias during a controlled withdrawal and rechallenge. No consensus exists for management of patients with statin intolerance. Many patients can eventually tolerate a statin but often at suboptimal doses. A subset of patients do well with nondaily regimens such as every other day or once weekly dosing. Some patients cannot tolerate statins at all, requiring nonstatin lipid-lowering medications--the benefit of which remains unclear with regard to preventing atherosclerotic events. Ultimately, statin intolerance undermines the drug adherence that is critical for achieving the benefits of lifelong lipid-lowering therapy. In conclusion, statin myopathy is a common challenge in lipid management, and further work is needed to establish a standard diagnostic criterion as well as treatment algorithms.
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Affiliation(s)
- Zahid Ahmad
- Division of Nutrition and Metabolic Diseases, Department of Internal Medicine, Center for Human Nutrition, University of Texas Southwestern Medical Center, Dallas, Texas.
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Abstract
Statins are currently the most efficacious and widely prescribed lipid-lowering medications. The 2013 ACC/AHA cholesterol guidelines provide a dramatic shift in treatment approach with a focus on fixed-dose statins matched to individual risk scores. Statin intolerance is not uncommon and can be challenging to diagnose and manage; however, several therapeutic strategies have been successful in achieving statin tolerance. Statin use is also associated with liver enzyme elevations and increased risk of incident diabetes, but studies show these individuals benefit from statins. Several guidelines exist and statin use is expected to increase with the new cholesterol guidelines bringing along new challenges for prescribers. This review article will provide practical considerations for statin use and management of statin intolerance.
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Affiliation(s)
- Kazeen Abdullah
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Texas, US
| | - Anand Rohatgi
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Texas, US
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Abstract
Statin drugs are highly effective in lowering blood concentrations of LDL-cholesterol, with concomitant reduction in risk of major cardiovascular events. Although statins are generally regarded as safe and well-tolerated, some users develop muscle symptoms that are mostly mild but in rare cases can lead to life-threatening rhabdomyolysis. The SEARCH genome-wide association study, which has been independently replicated, found a significant association between the rs4149056 (c.521T>C) single-nucleotide polymorphism (SNP) in the SLCO1B1 gene, and myopathy in individuals taking 80 mg simvastatin per day, with an odds ratio of 4.5 per rs4149056 C allele. The purpose of this paper is to assemble evidence relating to the analytical validity, clinical validity and clinical utility of using SLCO1B1 rs4149056 genotyping to inform choice and dose of statin treatment, with the aim of minimising statin-induced myopathy and increasing adherence to therapy. Genotyping assays for the rs4149056 SNP appear to be robust and accurate, though direct evidence for the performance of array-based platforms in genotyping individual SNPs was not found. Using data from the SEARCH study, calculated values for the clinical sensitivity, specificity, positive- and negative-predictive values of a test for the C allele to predict definite or incipient myopathy during 5 years of 80 mg/day simvastatin use were 70.4%, 73.7%, 4.1% and 99.4% respectively. There is a need for studies comparing the clinical validity of SLCO1B1 rs4149056 genotyping with risk scores for myopathy based on other factors such as racial background, statin type and dose, gender, body mass index, co-medications and co-morbidities. No direct evidence was found for clinical utility of statin prescription guided by SLCO1B1 genotype.
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Affiliation(s)
- Alison Stewart
- McKing Consulting Corp., Atlanta, Georgia, USA; Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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25
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Mancini GBJ, Tashakkor AY, Baker S, Bergeron J, Fitchett D, Frohlich J, Genest J, Gupta M, Hegele RA, Ng DS, Pearson GJ, Pope J. Diagnosis, prevention, and management of statin adverse effects and intolerance: Canadian Working Group Consensus update. Can J Cardiol 2013; 29:1553-68. [PMID: 24267801 DOI: 10.1016/j.cjca.2013.09.023] [Citation(s) in RCA: 119] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Revised: 09/24/2013] [Accepted: 09/24/2013] [Indexed: 12/21/2022] Open
Abstract
The Proceedings of a Canadian Working Group Consensus Conference, first published in 2011, provided a summary of statin-associated adverse effects and intolerance and management suggestions. In this update, new clinical studies identified since then that provide further insight into effects on muscle, cognition, cataracts, diabetes, kidney disease, and cancer are discussed. Of these, the arenas of greatest controversy pertain to purported effects on cognition and the emergence of diabetes during long-term therapy. Regarding cognition, the available evidence is not strongly supportive of a major adverse effect of statins. In contrast, the linkage between statin therapy and incident diabetes is more firm. However, this risk is more strongly associated with traditional risk factors for new-onset diabetes than with statin itself and any possible negative effect of new-onset diabetes during statin treatment is far outweighed by the cardiovascular risk reduction benefits. Additional studies are also discussed, which support the principle that systematic statin rechallenge, and lower or intermittent statin dosing strategies are the main methods for dealing with suspected statin intolerance at this time.
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Affiliation(s)
- G B John Mancini
- Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
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Mampuya WM, Frid D, Rocco M, Huang J, Brennan DM, Hazen SL, Cho L. Treatment strategies in patients with statin intolerance: the Cleveland Clinic experience. Am Heart J 2013; 166:597-603. [PMID: 24016512 DOI: 10.1016/j.ahj.2013.06.004] [Citation(s) in RCA: 132] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2013] [Accepted: 06/02/2013] [Indexed: 11/17/2022]
Abstract
BACKGROUND Statin therapy is a proven effective treatment of hyperlipidemia. However, a significant number of patients cannot tolerate statins. This study was conducted to review treatment strategies for patients intolerant to statin therapy with a focus on intermittent statin dosing. METHODS AND RESULTS We performed a retrospective analysis of medical records of 1,605 patients referred to the Cleveland Clinic Preventive Cardiology Section for statin intolerance between January 1995 and March 2010 with at least a 6-month follow-up. The changes in lipid profile, achievement of low-density lipoprotein cholesterol (LDL-C) goals, and statin tolerance rate were analyzed. Most (72.5%) of patients with prior statin intolerance were able to tolerate a statin for the median follow-up time of 31 months. Patients on intermittent statin dosing (n = 149) had significantly lower LDL-C reduction compared with daily dosing group (n = 1,014; 21.3% ± 4.0% vs 27.7% ± 1.4%, P < .04). However, compared with the statin discontinued group (n = 442), they had a significantly higher LDL-C reduction (21.3% ± 4.0% vs 8.3 ± 2.2%, P < .001), and a significantly higher portion achieved their Adult Treatment Panel III goal of LDL-C (61% vs 44%, P < .05). There was a trend toward a decrease in all-cause mortality at 8 years for patients on daily and intermittent statin dosing compared with those who discontinued statin (P = .08). CONCLUSIONS Most patients with previous statin intolerance can tolerate subsequent trial of statin. A strategy of intermittent statin dosing can be an effective therapeutic option in some patients and may result in reduction in LDL-C and achievement of LDL-C goals.
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Affiliation(s)
- Warner M Mampuya
- Service de cardiologie, Centre Hospitalier Universitaire de Sherbrooke 3001, Sherbrooke, Québec, Canada
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Goldberg AS, DeGorter MK, Ban MR, Kim RB, Hegele RA. Efficacy and Plasma Drug Concentrations With Nondaily Dosing of Rosuvastatin. Can J Cardiol 2013; 29:915-9. [DOI: 10.1016/j.cjca.2012.12.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Revised: 12/27/2012] [Accepted: 12/27/2012] [Indexed: 01/07/2023] Open
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Anderson TJ, Grégoire J, Hegele RA, Couture P, Mancini GBJ, McPherson R, Francis GA, Poirier P, Lau DC, Grover S, Genest J, Carpentier AC, Dufour R, Gupta M, Ward R, Leiter LA, Lonn E, Ng DS, Pearson GJ, Yates GM, Stone JA, Ur E. 2012 update of the Canadian Cardiovascular Society guidelines for the diagnosis and treatment of dyslipidemia for the prevention of cardiovascular disease in the adult. Can J Cardiol 2013; 29:151-67. [PMID: 23351925 DOI: 10.1016/j.cjca.2012.11.032] [Citation(s) in RCA: 539] [Impact Index Per Article: 49.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2012] [Revised: 11/29/2012] [Accepted: 11/29/2012] [Indexed: 12/15/2022] Open
Abstract
Many developments have occurred since the publication of the widely-used 2009 Canadian Cardiovascular Society (CCS) Dyslipidemia guidelines. Here, we present an updated version of the guidelines, incorporating new recommendations based on recent findings and harmonizing CCS guidelines with those from other Societies. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) system was used, per present standards of the CCS. The total cardiovascular disease Framingham Risk Score (FRS), modified for a family history of premature coronary disease, is recommended for risk assessment. Low-density lipoprotein cholesterol remains the primary target of therapy. However, non-high density lipoprotein cholesterol has been added to apolipoprotein B as an alternate target. There is an increased emphasis on treatment of higher risk patients, including those with chronic kidney disease and high risk hypertension. The primary panel has recommended a judicious use of secondary testing for subjects in whom the need for statin therapy is unclear. Expanded information on health behaviours is presented and is the backbone of risk reduction in all subjects. Finally, a systematic approach to statin intolerance is advocated to maximize appropriate use of lipid-lowering therapy. This document presents the recommendations and principal conclusions of this process. Along with associated Supplementary Material that can be accessed online, this document will be part of a program of knowledge translation. The goal is to increase the appropriate use of evidence-based cardiovascular disease event risk assessment in the management of dyslipidemia as a fundamental means of reducing global risk in the Canadian population.
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Affiliation(s)
- Todd J Anderson
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada.
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Feng Q, Wilke RA, Baye TM. Individualized risk for statin-induced myopathy: current knowledge, emerging challenges and potential solutions. Pharmacogenomics 2012; 13:579-94. [PMID: 22462750 DOI: 10.2217/pgs.12.11] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Skeletal muscle toxicity is the primary adverse effect of statins. In this review, we summarize current knowledge regarding the genetic and nongenetic determinants of risk for statin induced myopathy. Many genetic factors were initially identified through candidate gene association studies limited to pharmacokinetic (PK) targets. Through genome-wide association studies, it has become clear that SLCO1B1 is among the strongest PK predictors of myopathy risk. Genome-wide association studies have also expanded our understanding of pharmacodynamic candidate genes, including RYR2. It is anticipated that deep resequencing efforts will define new loci with rare variants that also contribute, and sophisticated computational approaches will be needed to characterize gene-gene and gene-environment interactions. Beyond environment, race is a critical covariate, and its influence is only partly explained by geographic differences in the frequency of known pharmacodynamic and PK variants. As such, admixture analyses will be essential for a full understanding of statin-induced myopathy.
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Affiliation(s)
- QiPing Feng
- Department of Medicine, Vanderbilt University Medical Center, Oates Institute for Experimental Therapeutics, Nashville, TN, USA
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Treatment of familial hypercholesterolemia: is there a need beyond statin therapy? Curr Atheroscler Rep 2012; 14:11-6. [PMID: 22135161 DOI: 10.1007/s11883-011-0215-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Familial hypercholesterolemia (FH) is a genetic lipid disorder that is characterized by severely elevated cholesterol levels and premature cardiovascular disease. Both the heterozygous and homozygous forms of FH require aggressive cholesterol-lowering therapy. Statins alone frequently do not lower these patients' cholesterol to therapeutic levels, and some patients are intolerant to statins. Combination or monotherapy with other current pharmacotherapies are options, but even with these some FH patients do not meet their low-density lipoprotein (LDL) cholesterol goals. In the cases of statin intolerance, LDL apheresis may be another treatment option. There are currently several novel therapies in development for LDL lowering that target either production or catabolism of LDL, plaque regression, and potentially gene transfer. We conclude that there is a need beyond statins for patients with FH, especially in cases of statin intolerance, and when even the highest doses of statin do not get patients to goal cholesterol levels.
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Li M, Al-Sarraf A, Mattman A, Frohlich J. Use of once-weekly statin in combination with ezetimibe in a patient with mitochondrial disease. BMJ Case Rep 2012; 2012:bcr1220115369. [PMID: 22604766 PMCID: PMC3339188 DOI: 10.1136/bcr.12.2011.5369] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The authors describe a patient with personal and family history of muscle pains highly suggestive of mitochondrial disease. She presented with familial combined hyperlipidaemia with family history of premature coronary artery disease. After 4-week therapy of 5 mg of rosuvastatin once a week combined with 10 mg of ezetimibe daily, the low-density lipoprotein cholesterol level was markedly decreased from 3.88 to 2.82 mmol/l (27.3% reduction). She has experienced no adverse effects after 6 month treatment. The results suggest that the combination therapy of low-dose once-weekly rosuvastatin and daily ezetimibe could be used as an effective regimen for patients with mitochondrial disease.
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Affiliation(s)
- Min Li
- Healthy Heart Program Prevention Clinic, Vancouver, Canada
| | | | - Andre Mattman
- Department of Pathology and Laboratory Medicine, St Paul’s Hospital, Vancouver, Canada
| | - Jiri Frohlich
- Healthy Heart Program Prevention Clinic, Vancouver, Canada
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Meek C, Wierzbicki AS, Jewkes C, Twomey PJ, Crook MA, Jones A, Viljoen A. Daily and intermittent rosuvastatin 5 mg therapy in statin intolerant patients: an observational study. Curr Med Res Opin 2012; 28:371-8. [PMID: 22256801 DOI: 10.1185/03007995.2012.657302] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To examine the efficacy and tolerability of rosuvastatin 5 mg at daily and non-daily dosing regimens. RESEARCH DESIGN AND METHODS A retrospective survey was conducted at nine primary, secondary and tertiary healthcare centres in the United Kingdom. MAIN OUTCOME MEASURES Changes in lipid fractions from baseline values after more than 3 months' treatment. RESULTS A total of 325 patients were identified. These patients were aged 63 ± 10 years, 50% male and prescription was mostly for primary prevention of cardiovascular disease (CVD) (59%). Co-morbidities included: established CVD present in 41%, type 2 diabetes mellitus (15%), hypertension (74%) and smoking (9%). Adverse effects had been documented to simvastatin (75%) or atorvastatin (63%). A total of 289 patients (89%) tolerated rosuvastatin well and were still adherent after a median follow-up of 14.9 (3-79) months. The remainder (n = 36; 11%) discontinued the medication after median 5 months' treatment due to adverse effects. Efficacy was assessed in 224 patients who had adequate data. Baseline lipids were total cholesterol (TC) 7.41 ± 1.50 mmol/L, triglycerides (TG) 2.26 (range 0.36-18.4) mmol/L; high density lipoprotein cholesterol (HDL-C) 1.43 ± 0.47 mmol/L and low density lipoprotein cholesterol (LDL-C) 4.76 ± 1.38 mmol/L. Daily rosuvastatin (n = 134) reduced mean TC by 31%, TG 15% and LDL-C 43% (p < 0.001). Rosuvastatin 5 mg 2-3 times weekly (n = 79) reduced TC 26%, TG 16% and LDL-C 32% (p < 0.001). Weekly rosuvastatin (n = 11) reduced TC 17%, LDL-C by 23% (p < 0.001) but had no effect on TGs. Targets were attained in 17% of CHD-risk equivalent patients and 41% of primary prevention patients by National Cholesterol Education Program criteria and 27% and 68% using UK targets. No myositis or rhabdomyolysis was observed and alanine aminotransferase (ALT) and creatine kinase (CK) were similar to baseline. CONCLUSIONS In this retrospective observational multicentre study, rosuvastatin 5 mg was found to be safe and biochemically effective either as daily or intermittent therapy in patients intolerant to other conventional statin regimens.
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Affiliation(s)
- Claire Meek
- East & North Hertfordshire NHS Trust, Lister Hospital, Stevenage, Hertfordshire, UK
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Katsiki N, Athyros VG, Karagiannis A, Mikhailidis DP. Efficacy and tolerability of once-weekly rosuvastatin in patients with previous statin intolerance. J Clin Lipidol 2012; 6:93. [DOI: 10.1016/j.jacl.2011.09.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2011] [Accepted: 09/15/2011] [Indexed: 11/25/2022]
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