Systematic data on discontinuation of statins in routine practice of medicine are limited.
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.
A retrospective cohort study.
Practices affiliated with Brigham and Women's Hospital and Massachusetts General Hospital in Boston.
Adults who received a statin prescription between 1 January 2000 and 31 December 2008.
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.
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.
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.
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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Author, Article, and Disclosure Information
From Key Laboratory of Endocrinology, Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China; and Brigham and Women's Hospital, Harvard Medical School, and Partners HealthCare System, Boston, Massachusetts.
Acknowledgment: The authors thank Dr. Robert Dluhy for his thoughtful review of the manuscript.
Grant Support: From the National Library of Medicine (5RC1LM010460), the Diabetes Action Research and Education Foundation, and the Chinese National Key Program of Clinical Science.
Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M12-1580.
Reproducible Research Statement: Study protocol and data set: Not available. Statistical code: Available from Dr. Turchin (e-mail, aturchin@partners.
Corresponding Author: Alexander Turchin, MD, MS, Division of Endocrinology, Brigham and Women's Hospital, 221 Longwood Avenue, Boston, MA 02115; e-mail, aturchin@partners.
Current Author Addresses: Dr. Zhang: Department of Endocrinology, Peking Union Medical College Hospital, No.1 Shuaifuyuan, Wangfujing, DongCheng District, Beijing, 100730 China.
Dr. Plutzky: Director, The Vascular Disease Prevention Program, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, 77 Avenue Louis Pasteur, NRB 742, Boston, MA 02115.
Mr. Skentzos: 160 North Frances Street, Sunnyvale, CA 94086.
Ms. Morrison: Tulane University School of Public Health and Tropical Medicine, Department of Epidimiology, 1440 Canal Street, New Orleans, LA 70112-2699.
Dr. Mar: Clinical Informatics Research & Development, Partners Information Systems, 93 Worcester Street, Suite 201, Wellesley, MA 02481.
Drs. Shubina and Turchin: Division of Endocrinology, Brigham and Women's Hospital, 221 Longwood Avenue, Boston, MA 02115.
Author Contributions: Conception and design: H. Zhang, J. Plutzky, P. Mar, A. Turchin.
Analysis and interpretation of data: H. Zhang, J. Plutzky, A. Turchin.
Drafting of the article: H. Zhang.
Critical revision of the article for important intellectual content: H. Zhang, J. Plutzky, F. Morrison, P. Mar, M. Shubina, A. Turchin.
Final approval of the article: J. Plutzky, M. Shubina, A. Turchin.
Statistical expertise: M. Shubina.
Obtaining of funding: A. Turchin.
Administrative, technical, or logistic support: S. Skentzos, F. Morrison, P. Mar.
Collection and assembly of data: H. Zhang, S. Skentzos, P. Mar.