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Abstract of the day - How common is statin intolerance?

27 Aug 2021
Abstract of the day

In clinical practice, statin intolerance (SI) limits the effective treatment of patients at risk of, or with, cardiovascular disease (CVD). At a ‘Highlights from the Young’ session today, Doctor Ibadete Bytyçi (University Clinical Centre of Kosovo, Pristina, Republic of Kosovo) presents the results of a large-scale meta-analysis investigating the prevalence of SI.

The analysis was performed within the International Lipid Expert Panel (ILEP) and the Lipid and Blood Pressure Meta-analysis Collaboration (LBPMC) Group, both founded by Professor Maciej Banach (Medical University of Lodz, Poland). The group searched electronic databases up to the end of March 2021, and assessed the primary endpoints of overall SI prevalence and SI prevalence based on different diagnostic criteria. The secondary endpoint was SI prevalence within different CVD settings.

Overall SI prevalence was found to be 9.1% (95% confidence interval 8.1–10) based on 176 studies (112 randomised clinical trials [RCTs] and 64 cohort studies) involving over 4 million patients. Based on recognised international definitions, SI prevalence was even lower and was consistent between the different diagnostic criteria used (National Lipid Association, 7.0%; ILEP, 6.7%; and European Atherosclerosis Society, 5.9%). As expected, the prevalence of SI was lower in RCTs than in cohort studies (4.9% vs. 17%; p<0.001).

When assessed by CVD setting, SI prevalence appeared high in studies combining primary and secondary prevention (18.2%), which was mainly driven by data from cohort studies. SI was lower in studies focused only on primary prevention (8.2%) or secondary prevention (9.1%).

Among patients undergoing primary prevention, SI prevalence was 9% for familial hypercholesterolaemia, 13% for dyslipidaemia and 6% for diabetes mellitus. Among patients undergoing secondary prevention, SI prevalence was 8% for stable coronary artery disease and 13% for myocardial infarction.

For the first time, the analysis also confirmed that older age, female gender, Asian and African American races, obesity, type 2 diabetes, alcohol use, hypothyroidism and chronic liver and renal diseases were associated with increased risk of SI, as were increased statin doses and the concomitant administration of antiarrhythmics.

The authors conclude that overall SI prevalence is low and that the findings support the concept that complete SI may be often overestimated, highlighting the need for careful examination of patients presenting with SI. They suggest that clinicians should use these results to encourage statin adherence among their patients. 


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