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Discontinuation of Statins in Routine Care Settings: A Cohort Study
Open accessAbstract
BACKGROUND: Systematic data on discontinuation of statins in routine practice of medicine are limited. OBJECTIVE: To investigate the reasons for statin discontinuation and the role of statin-related events (clinical events or symptoms believed to have been caused by statins) in routine care settings. DESIGN: A retrospective cohort study. SETTING: Practices affiliated with Brigham and Women's Hospital and Massachusetts General Hospital in Boston. PATIENTS: Adults who received a statin prescription between 1 January 2000 and 31 December 2008. MEASUREMENTS: Information on reasons for statin discontinuations was obtained from a combination of structured electronic medical record entries and analysis of electronic provider notes by validated software. RESULTS: Statins were discontinued at least temporarily for 57 292 of 107 835 patients. Statin-related events were documented for 18 778 (17.4%) patients. Of these, 11 124 had statins discontinued at least temporarily; 6579 were rechallenged with a statin over the subsequent 12 months. Most patients who were rechallenged (92.2%) were still taking a statin 12 months after the statin-related event. Among the 2721 patients who were rechallenged with the same statin to which they had a statin-related event, 1295 were receiving the same statin 12 months later, and 996 of them were receiving the same or a higher dose. LIMITATIONS: Statin discontinuations and statin-related events were assessed in practices affiliated with 2 academic medical centers. Utilization of secondary data could have led to missing or misinterpreted data. Natural-language-processing tools used to compensate for the low (30%) proportion of reasons for statin discontinuation documented in structured electronic medical record fields are not perfectly accurate. CONCLUSION: Statin-related events are commonly reported and often lead to statin discontinuation. However, most patients who are rechallenged can tolerate statins long-term. This suggests that many of the statin-related events may have other causes, are tolerable, or may be specific to individual statins rather than the entire drug class. PRIMARY FUNDING SOURCE: National Library of Medicine, Diabetes Action Research and Education Foundation, and Chinese National Key Program of Clinical Science.
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“Statin-associated muscle symptoms cover a broader range of clinical presentations, usually with normal or minimally elevated CK levels”
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“with a prevalence of 7–29% in registries and observational studies.”
In the citing paper
“From a treatment viewpoint, Zhang et al.14 showed that 90% of patients reporting SAMS to one statin were able to tolerate an alternative statin with continued use after 12 months”
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“suggesting that statin-attributed symptoms may have had other causes or were not generalizable to other statins.”
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Grundy, S. M., Stone, N. J., Bailey, A. L., Beam, C., Birtcher, K. K., Blumenthal, R. S., Braun, L. T., de Ferranti, S., Faiella-Tommasino, J., Forman, D. E., et al. (2019) · Circulation · doi:10.1161/cir.0000000000000625 · Cited by 6,185
Grundy, S. M., Stone, N. J., Bailey, A. L., Beam, C., Birtcher, K. K., Blumenthal, R. S., Braun, L. T., de Ferranti, S., Faiella-Tommasino, J., Forman, D. E., et al. (2019) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2018.11.003 · Cited by 2,691
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Collins, R., Reith, C., Emberson, J., Armitage, J., Baigent, C., Blackwell, L., Blumenthal, R., Danesh, J., Smith, G. D., DeMets, D., et al. (2016) · The Lancet · doi:10.1016/s0140-6736(16)31357-5 · Cited by 1,857
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Metadata
- Authors
- Zhang, H., Plutzky, J., Skentzos, S., Morrison, F., Mar, P., Shubina, M., & Turchin, A.
- Affiliations
- Brigham and Women's Hospital (US)
- Venue
- Annals of Internal Medicine
- Publisher
- American College of Physicians
- Published
- 2013-04-02
- Volume
- 158
- Issue
- 7
- Pages
- 526-534
- ISSN
- 0003-4819 (ISSN-L)
- 1539-3704
- PMC
- PMC3692286
- OpenAlex
- W1998569580
- Cited by
- 548
- References
- 50
- Citations by year
- 2026: 25 · 2025: 15 · 2024: 19 · 2023: 27 · 2022: 43 · 2021: 34 · 2020: 41 · 2019: 49 · 2018: 42 · 2017: 52 · 2016: 77 · 2015: 54 · 2014: 46 · 2013: 24
- FWCI
- 65.99
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Annals of Internal Medicine (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- U.S. National Library of Medicine (RC1LM010460)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Lipoproteins and Cardiovascular Health
- Health Sciences › Medicine › Family Practice › Medication Adherence and Compliance
- Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Toxicology › Pharmacovigilance and Adverse Drug Reactions
- Keywords
- statins, statin discontinuation, statin rechallenge, drug tolerability, lipid-lowering therapy, primary care, electronic health records, natural language processing
- MeSH terms
- Documentation, Humans, Hypercholesterolemia, Natural Language Processing, Retrospective Studies, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Withholding Treatment, Electronic Health Records
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- CoChat. (2026). Citation check: Discontinuation of Statins in Routine Care Settings: A Cohort Study. https://app.cochat.ai/papers/10.7326/0003-4819-158-7-201304020-00004
- The paper
- Zhang, H., Plutzky, J., Skentzos, S., Morrison, F., Mar, P., Shubina, M., & Turchin, A. (2013). Discontinuation of Statins in Routine Care Settings: A Cohort Study. Annals of Internal Medicine. https://doi.org/10.7326/0003-4819-158-7-201304020-00004
