When statin therapy stops: implications for the patient.
OBJECTIVE
To discuss recent findings on the implications of statin discontinuation.


RESULTS
The beneficial effects of statins in decreasing inflammatory markers, cardiovascular events, cardiovascular mortality, and all-cause mortality in patients with and without a history of cardiovascular disease have been underscored in past and recent studies. However, patients often do not adhere to their statin therapy. Discontinuation rates, though improved over time, remain high not only in primary but also in secondary prevention patients in the clinical practice. Recent studies have found that discontinuing statins, particularly after acute events (e.g. acute myocardial infarction or stroke), has a harmful effect on cardiovascular outcomes and all-cause mortality; patients who discontinued their statin therapy had worse outcomes than those who were never prescribed statins. This could be attributed to a biological rebound phenomenon.


CONCLUSIONS
Statin therapy has a number of beneficial effects on patient outcomes and should be prescribed according to current cardiovascular disease guidelines. Importantly, statin discontinuation is associated with harmful outcomes. Clinicians should become more aware of these effects and counsel their patients to adhere to their statin therapy. Current evidence suggests that, unless contraindicated, statins should not be discontinued, especially after an acute vascular event.
Daskalopoulou
Stella S
SS
Division of Internal Medicine, Department of Medicine, McGill University, McGill University Health Centre, Montreal, Québec, Canada. stella.daskalopoulou@mcgill.ca
D000924:Anticholesteremic Agents / Q000627:therapeutic use*; D003324:Coronary Artery Disease / Q000188:drug therapy* / Q000401:mortality; D004730:Endothelium, Vascular / Q000187:drug effects; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D007249:Inflammation / Q000188:drug therapy; D055118:Medication Adherence; D012307:Risk Factors; D055502:Secondary Prevention
D000924:Anticholesteremic Agents; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors