Which Patient Groups Are Most Likely to Stop Statin Therapy?

Although many patients who are prescribed statins for either primary or secondary prevention of cardiovascular disease (CVD) stop treatment, a majority of them restart, according to a new study.

Recently, guidelines in the United States and United Kingdom have lowered the threshold for considering statins for patients without CVD. However, there have been concerns about the balance of benefits and harms of statin use, especially in patients with lower absolute risk of cardiovascular disease.
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“Although observational studies have examined the pattern of uptake of statins and of unintended effects from statin use, it is unclear which patient characteristics affect discontinuation, in what ways, and by how much,” the researchers wrote.

In October 2014, the researchers collected data from 664 general practices in the Clinical Practice Research Datalink in the United Kingdom.

Their analysis included patients aged 25 to 84 years who were prescribed statins for either primary or secondary prevention of CVD.

Between January 2002 and September 2013, the researchers identified 431,023 patients prescribed statins for primary prevention and 139,314 prescribed for secondary prevention.

After a median follow-up time of 137 weeks, 47% of patients taking statins for primary prevention had discontinued use, and of those, 72% restarted treatment.

After a median follow-up of 182 weeks, 41% of patients taking statins for secondary prevention discontinued use, and 75% of them had restarted treatment.

Patients aged 50 years and younger and 75 years and older, women, and patients with chronic liver disease were more likely to stop treatment and less likely to restart.

In addition, patients in ethnic minority groups, current smokers, and patients with type 1 diabetes were more likely to stop treatment but more likely to restart, and those with hypertension and type 2 diabetes were less likely to stop treatment and more likely to restart.

“Although a large proportion of statin users discontinue, many of them restart,” the researchers concluded. “For many patient groups previously considered as ‘stoppers,’ the problem of statin treatment ‘stopping’ could be part of the wider issue of poor adherence,” the researchers concluded.

“Identification of patient groups associated with completely stopping or stop-starting behavior has positive implications for patients and doctors as well as suggesting areas for future research.”

—Amanda Balbi

Reference:

Vinogradova Y, Coupland C, Brindle P, Hippisley-Cox J. Discontinuation and restarting in patients on statin treatment: prospective open cohort study using a primary care database [published online June 28, 2016]. BMJ. doi: http://dx.doi.org/10.1136/bmj.i3305.