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Statin side effects are most likely cause of failure to meet cholesterol targets

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Side effects from statins are the strongest predictor of failure to meet low-density lipoprotein (LDL) cholesterol targets, according to Norwegian researchers.

Other predictors of failure to hit targets were statin non-adherence and use of weaker statins, according to their study findings published in the European Journal of Preventive Cardiology.

“Patients who experience side effects are probably more likely to reduce or terminate statin use”

John Munkhaugen

The study, which forms part of the NORwegian COR (NOR-COR) prevention project, included 1,095 patients hospitalised with a first or recurrent coronary event or treatment who were identified from medical records at two hospitals.

Information was collected from medical records, a self-report questionnaire, clinical examinations, and blood samples while patients were in hospital and at follow-up after two to 36 months.

They highlighted that latest European guidelines on cardiovascular disease prevention in clinical practice recommend an LDL cholesterol goal of 1.8mmol/l or a reduction of at least 50% if the baseline is between 1.8 and 3.5mmol/l.

In their study, the researchers found that 57% of patients were not meeting the LDL target of 1.8mmol/l at follow-up.

Statin specific side effects – mainly muscle complaints – low statin adherence, and moderate- or low-intensity statin therapy were the main reasons for failing to meet the target.

“Individual variations in how the body reacts to and uses the drug may also play a role”

John Munkhaugen

Patients with side effects were more than three times more likely to miss the cholesterol target than those without side effects.

In addition, those who did not take their statins were three times more likely to miss the target than patients who did take them.

Meanwhile, patients prescribed moderate- or low-intensity statins were 62% more likely to miss the target than those prescribed high-intensity statins.

Lead author Dr John Munkhaugen, fromDrammen Hospital in Norway, said: “The findings show that the focus for interventions to improve LDL cholesterol control are statin side effects, and adherence to and prescription of sufficiently potent statins.”

Links between non-adherence and intensity of therapy on cholesterol were likely to be explained by the pharmacological effects of the drug, he noted, as not taking the prescribed amount or being prescribed a weaker statin meant “there is less drug in the body to act and lower LDL”.

However, Dr Munkhaugen said more research was needed on why side effects of statins had such a big effect on meeting cholesterol goals.

“Patients who experience side effects are probably more likely to reduce or terminate statin use, or may be prescribed a weaker drug or take them off statins altogether,” he said. “Individual variations in how the body reacts to and uses the drug may also play a role.”

He highlighted that reasons for statin non-adherence were a “complex interaction between factors related to the patient and the healthcare system”.

“Interventions aiming to improve statin adherence have been a priority in recent years, but the success has been modest and short-lived,” he said.

The study found that the use of high-intensity statins was significantly more frequent in patients who achieved the cholesterol target.

But Dr Munkhaugen cautioned that the relationship with adherence and side effects needed to be “clarified before advice can be given about the potency of statins that should be prescribed”.

“Our findings point to the need for more research on ways to ensure adherence and prescription of sufficiently potent statins, while at the same time addressing side effects,” he said.

He added: “Surprisingly, low socioeconomic status and psychosocial factors did not predict failure to control LDL cholesterol.”

Drammen Hospital/Oslo University

Statin side effects main cause of poor cholesterol control

John Munkhaugen and fellow researcher Elise Sverre, from Oslo University, with other findings from the NORwegian COR prevention project


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