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Fewer than 1 in 10 statin takers experience side effects

European Heart Journal
Reuters Health - 17/02/2022 - While many patients quit statins because of perceived side effects, a new meta-analysis shows less than 10% actually experience statin intolerance.

The research, which included 176 studies and more than 4 million patients, revealed an overall statin intolerance prevalence of 9.1% or less.

"Both physicians and patients should not be afraid of taking statins, as 91% of patients might tolerate them well without any side effects, and when the statin intolerance is defined based on approved definitions, it is even 93%, which is a better result in comparison to some anti-hypertensive, anti-diabetic or antithrombotic drugs used commonly in cardiology," said Dr. Maciej Banach the Medical University of Lodz, Poland.

"Our analysis also supports the physicians in the every-day work with these patients, as it clearly showed that there are some risk factors and conditions that might increase the risk of statin intolerance, like hypothyroidism, chronic liver and kidney disease, uncontrolled diabetes, alcohol consumption, and some drugs, like calcium channel blockers or anti-arrhythmics," he told Reuters Health by email.

"We should always emphasize and educate our patients that when you are adherent to therapy for five years, you might reduce the risk of cardiovascular events by 20-25%, if you are adherent for 40 years or more, you might reduce the risk by even 50-55%, so it is the most preventive therapy in cardiology, and we have very strong data, based on the results from thousands of studies, that statins may simply prolong your life," said Dr. Banach, who is secretary of the European Atherosclerosis Society and president of the International Lipid Expert Panel.

The findings appear in the European Heart Journal.

To take a closer look at the likelihood of statin intolerance (SI), Dr. Banach and his colleagues scoured the medical literature for studies that reported the prevalence of SI either in primary or secondary prevention that had at least 100 participants and available criteria for SI diagnosis.

They found 112 randomized controlled trials and 64 cohort studies that included 4,143,517 patients. The researchers' analysis revealed a pooled SI incidence of 9.1%. Certain conditions were associated with a significantly greater risk of SI: age 65 or older (odds ratio, 1.33), female gender (OR, 1.47), obesity (OR, 1.30), diabetes mellitus (OR, 1.26) and hypothyroidism (OR, 1.37).

When patients say they are experiencing side effects, clinicians should investigate to determine whether the drug is indeed causing them problems, such as muscle pain, Dr. Banach said.

"If we confirm that the muscle pain may be directly associated with statin therapy, we should look for risk factors/conditions that might have caused this, including the history of the patient and family, hypothyroidism, impaired liver and kidney function, alcohol consumption, uncontrolled diabetes and drug interactions."

Otherwise, it's likely the patient is experiencing a nocebo effect, Dr. Banach said, adding that doctors should focus on patient education if this is the case.

The new study held no surprises for Dr. Robert Rosenson, director of cardiometabolic disorders at the Mount Sinai Hospital and a professor of medicine and cardiology at the Icahn School of Medicine at Mount Sinai, in New York.

"It showed that these side effects were most common in the elderly, women, and people with kidney disease - that's been known for decades," Dr. Rosenson, who was not involved in the research, told Reuters Health by phone. "The good thing about the report is that it found the incidence of statin muscle complaints to be less than many people anticipate. It's a good message to those who listen to the internet, to their neighbors and Dr. Google."

The study had no commercial funding. Dr. Banach and some of his co-authors report financial ties to statin makers.

SOURCE: https://bit.ly/3HYoh39 European Heart Journal, online February 15, 2022.

By Linda Carroll

© 2023 The Author(s). Published by Medicom Medical Publishers.
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