Document Detail


Discontinuation of statins in routine care settings: a cohort study.
MedLine Citation:
PMID:  23546564     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
Huabing Zhang; Jorge Plutzky; Stephen Skentzos; Fritha Morrison; Perry Mar; Maria Shubina; Alexander Turchin
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Publication Detail:
Type:  Journal Article; Multicenter Study; Research Support, N.I.H., Extramural; Research Support, U.S. Gov't, Non-P.H.S.    
Journal Detail:
Title:  Annals of internal medicine     Volume:  158     ISSN:  1539-3704     ISO Abbreviation:  Ann. Intern. Med.     Publication Date:  2013 Apr 
Date Detail:
Created Date:  2013-04-02     Completed Date:  2013-05-22     Revised Date:  2014-04-04    
Medline Journal Info:
Nlm Unique ID:  0372351     Medline TA:  Ann Intern Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  526-34     Citation Subset:  AIM; IM    
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MeSH Terms
Descriptor/Qualifier:
Documentation
Electronic Health Records
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors / adverse effects*,  therapeutic use
Hypercholesterolemia / drug therapy*
Natural Language Processing
Retrospective Studies
Withholding Treatment
Grant Support
ID/Acronym/Agency:
5RC1LM010460/LM/NLM NIH HHS; RC1 LM010460/LM/NLM NIH HHS
Chemical
Reg. No./Substance:
0/Hydroxymethylglutaryl-CoA Reductase Inhibitors
Comments/Corrections
Comment In:
Ann Intern Med. 2013 Apr 2;158(7):562-3   [PMID:  23546569 ]
Ann Intern Med. 2013 Jul 2;159(1):74   [PMID:  23817714 ]
Ann Intern Med. 2013 Jul 2;159(1):74-5   [PMID:  23817715 ]
Ann Intern Med. 2013 Jul 2;159(1):75-6   [PMID:  23817716 ]
Ann Intern Med. 2013 Jul 2;159(1):73-4   [PMID:  23817713 ]
Nat Rev Cardiol. 2013 Jun;10(6):300   [PMID:  23591265 ]

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