Statin Intolerance May Raise Risk of Recurrent Myocardial Infarction

According to a recent study, statin intolerance was associated with a higher risk of recurrent myocardial infarction (MI) and coronary heart disease (CHD), but not with all-cause mortality.

The study evaluated the risks of MI, CHD, and all-cause mortality in 105,329 Medicare beneficiaries with either statin intolerance or high statin adherence who started a moderate- or high-intensity statin dosage after being hospitalized for MI between 2007 and 2013. Researchers followed-up with patients for a median of 1.9 to 2.3 years, and documented incidences of MI, CHD events, and mortality from 1 year after hospital discharge through December 2014.
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Patients were identified as statin intolerant if they switched to a lower dosage or discontinued statin therapy and started taking ezetimibe, were diagnosed with rhabdomyolysis or an antihyperlipidemic adverse event followed by a lowering of statin dosage, or switched between 3 or more types of statins within a year after starting therapy. High adherence in patients was categorized as having portion of days covered during the year after hospital discharge at 80% or more.

A total of 1741 patients (1.65%) had statin intolerance, and 55,567 patients (52.7%) had high statin adherence. Over the course of the study, 4450 recurrent MIs occurred, 6250 CHD events occurred, and 14,311 deaths occurred.

“The multivariate-adjusted hazard ratios (HR) comparing beneficiaries with statin intolerance versus those with high statin adherence were 1.50 (95% confidence interval [CI]: 1.30 to 1.73) for recurrent MI, 1.51 (95% CI: 1.34 to 1.70) for CHD events, and 0.96 (95% CI: 0.87 to 1.06) for all-cause mortality,” the researchers wrote.

Overall, researchers found that in comparison with high statin adherence, statin intolerance was associated with a 36% higher rate of recurrent MI (41.1 vs 30.1 per 1000 person-years, respectively), a 43% higher rate of CHD events (62.5 vs 43.8 per 1000 person-years, respectively), and a 15% lower rate of all-cause mortality (79.9 vs 94.2 per 1000 person-years, respectively).

—Melissa Weiss

Reference:

Serban MC, Colantonio LD, Manthripragada AD, et al. Statin intolerance and risk of coronary heart events and all-cause mortality following myocardial infarction. JACC. 2017;69(11):1386-1395.