Statin therapy in critical illness: an international survey of intensive care physicians' opinions, attitudes and practice

Statin therapy for acute respiratory distress syndrome: an individual patient data meta-analysis of randomised clinical trials

PURPOSE

We performed an individual patient data meta-analysis to assess the possible benefits and harms of statin therapy in adults with acute respiratory distress syndrome (ARDS) and to investigate effects in specific ARDS subgroups.

METHODS

We identified randomised clinical trials up to 31 October 2016 that had investigated statin therapy versus placebo in patients with ARDS. Individual patient data from each trial were compiled. Conventional two-stage meta-analyses were performed for primary and secondary outcomes, and one-stage regression models with single treatment-covariate interactions for subgroup analyses. Risk of bias was assessed using the Cochrane Risk of Bias Tool.

RESULTS

Six trials with a total of 1755 patients were included. For the primary outcomes, there was no significant effect of statin therapy on 28-day mortality [relative risk (RR) 1.03, 95% CI 0.86-1.23], ventilator-free days (mean difference 0.34 days, 95% CI -0.68 to 1.36) or serious adverse events (RR 1.14, 95% CI 0.84-1.53). There was a significantly increased incidence of raised serum creatine kinase or transaminase levels with statin therapy (106/879; 12.1%) versus control (78/876; 8.9%) (RR 1.40, 95% CI 1.07-1.83, p = 0.015). There were no significant treatment-covariate interactions in the predefined subgroups investigated.

CONCLUSIONS

We found no clinical benefit from initiation of statin therapy in adult patients with ARDS, either overall or in predefined subgroups. While there was an increased incidence of raised serum creatine kinase and transaminase levels, there was no difference in serious adverse events among groups. Therefore, we do not recommend initiation of statin therapy for the treatment of ARDS.

Developmentand Validation of a Questionnaire about Patient Knowledge of Adverse Effects of Statins

Statins are drugs that are well tolerated, but considering their extensive use, there are still concerns regarding their safety. Knowledge of patients about the side effects of statins has not been adequately studied, although timely recognition of the AES is of vital importance for improving the quality of patient care and reducing morbidity and suffering. The aim of this study was to develop and test a questionnaire for measuring the knowledge of patients about statin therapy about adverse effects of statins (AES).

This two-center cross-sectional study was conducted during the period from March 1, 2015 to April 1, 2016, taking place in pharmacies from the city of Belgrade and at the Department of Internal Medicine, Clinical Center in Kragujevac, Serbia. The study included 300 patients and 20 pharmacists.

The questionnaire showed satisfactory internal consistency, with Cronbach’s alpha of 0.898, good construction and homogeneity of questions. After splitting the questionnaire to two parts at random, Cronbach’s alphas were 0.834 and 0.842 for the both parts, respectively. Exploratory factorial analysis revealed two domains. The patients rated their knowledge of the side effects of statins 52.7±19.9 on the visual analogue scale.

Based on the results of this study, we believe that this questionnaire could be a useful tool for testing the knowledge of patients about adverse effects of statins and help physicians to identify patients with insufficient knowledge who should be additionally informed about it.