Statin intolerance and risk of coronary heart events and all-cause mortality following myocardial infarction
Open accessAbstract
Background Many patients report adverse reactions to, and may not tolerate, statin therapy. These patients may be at increased risk for coronary heart disease (CHD) events and mortality.Objectives This study evaluated the risk for recurrent myocardial infarction (MI), CHD events, and all-cause mortality in Medicare beneficiaries with statin intolerance and in those with high adherence to statin therapy.Methods We studied 105,329 Medicare beneficiaries who began a moderate- or high-intensity statin dosage after hospitalization for MI between 2007 and 2013. Statin intolerance was defined as down-titrating statins and initiating ezetimibe therapy, switching from statins to ezetimibe monotherapy, having International Classification of Diseases, 9th revision, diagnostic codes for rhabdomyolysis or an antihyperlipidemic adverse event, followed by statin down-titration or discontinuation, or switching between ≥3 types of statins within 1 year after initiation. High statin adherence over the year following hospital discharge was defined as proportion of days covered ≥80%. Recurrent MI, CHD events (recurrent MI or a coronary revascularization procedure), and mortality were identified from 1 year after hospital discharge through December 2014.Results Overall, 1,741 patients (1.65%) had statin intolerance, and 55,567 patients (52.8%) had high statin adherence. Over a median of 1.9 to 2.3 years of follow-up, there were 4,450 recurrent MIs, 6,250 CHD events, and 14,311 deaths. Compared to beneficiaries with high statin adherence, statin intolerance was associated with a 36% higher rate of recurrent MI (41.1 vs. 30.1 per 1,000 person-years, respectively), a 43% higher rate of CHD events (62.5 vs. 43.8 per 1,000 person-years, respectively), and a 15% lower rate of all-cause mortality (79.9 vs. 94.2 per 1,000 person-years, respectively). 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.Conclusions Statin intolerance was associated with an increased risk for recurrent MI and CHD events but not all-cause mortality.
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Statin discontinuation because of statin intolerance is associated with significantly increased cardiovascular morbidity and mortality.
“Statin discontinuation as a consequence of statin intolerance is associated with a significantly increased risk of CV morbidity and mortality (13).”
From The Role of Nutraceuticals in Statin Intolerant Patients (2018) · cites this paper as [13]
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- Authors
- Serban, M.-C., Colantonio, L. D., Manthripragada, A. D., Monda, K. L., Bittner, V. A., Banach, M., Chen, L., Huang, L., Dent, R., Kent, S. T., Muntner, P., & Rosenson, R. S.
- Affiliations
- University of Alabama at Birmingham (US)
- Amgen (United States) (US)
- Medical University of Lodz (PL)
- Esperion Therapeutics (United States) (US)
- Icahn School of Medicine at Mount Sinai (US)
- Corresponding author
- Muntner, Paul
- ORCID
- Venue
- Journal of the American College of Cardiology
- Publisher
- Elsevier BV
- Published
- 2017-03
- Volume
- 69
- Issue
- 11
- Pages
- 1386-1395
- ISSN
- 0735-1097 (ISSN-L)
- OpenAlex
- W2595226750
- Cited by
- 318
- References
- 37
- Citations by year
- 2026: 10 · 2025: 21 · 2024: 19 · 2023: 27 · 2022: 36 · 2021: 37 · 2020: 39 · 2019: 49 · 2018: 43 · 2017: 36
- FWCI
- 46.80
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of the American College of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Amgen
- Eli Lilly and Company
- Pfizer
- AstraZeneca
- Sanofi
- Regeneron Pharmaceuticals
- Valeant Pharmaceuticals International
- Medicines Company
- Topics
- Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Acute Myocardial Infarction Research
- Health Sciences › Medicine › Family Practice › Medication Adherence and Compliance
- Keywords
- statin intolerance, statin therapy, reinfarction, all-cause mortality, statin adherence, ezetimibe, rhabdomyolysis, adverse drug reactions, Medicare beneficiaries, secondary prevention after myocardial infarction, coronary revascularization, lipid-lowering therapy
- MeSH terms
- Aged, Aged, 80 and over, Female, Humans, Male, Myocardial Infarction, Retrospective Studies, United States, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Medication Adherence, Secondary Prevention
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