title: Treatment strategies in patients with statin intolerance: the Cleveland Clinic experience.
abstract: BACKGROUND
  Statin therapy is a proven effective treatment of hyperlipidemia. However, a significant number of patients cannot tolerate statins. This study was conducted to review treatment strategies for patients intolerant to statin therapy with a focus on intermittent statin dosing.
  
  
  RESULTS
  We performed a retrospective analysis of medical records of 1,605 patients referred to the Cleveland Clinic Preventive Cardiology Section for statin intolerance between January 1995 and March 2010 with at least a 6-month follow-up. The changes in lipid profile, achievement of low-density lipoprotein cholesterol (LDL-C) goals, and statin tolerance rate were analyzed. Most (72.5%) of patients with prior statin intolerance were able to tolerate a statin for the median follow-up time of 31 months. Patients on intermittent statin dosing (n = 149) had significantly lower LDL-C reduction compared with daily dosing group (n = 1,014; 21.3% ± 4.0% vs 27.7% ± 1.4%, P < .04). However, compared with the statin discontinued group (n = 442), they had a significantly higher LDL-C reduction (21.3% ± 4.0% vs 8.3 ± 2.2%, P < .001), and a significantly higher portion achieved their Adult Treatment Panel III goal of LDL-C (61% vs 44%, P < .05). There was a trend toward a decrease in all-cause mortality at 8 years for patients on daily and intermittent statin dosing compared with those who discontinued statin (P = .08).
  
  
  CONCLUSIONS
  Most patients with previous statin intolerance can tolerate subsequent trial of statin. A strategy of intermittent statin dosing can be an effective therapeutic option in some patients and may result in reduction in LDL-C and achievement of LDL-C goals.
authors.affiliation: Service de cardiologie, Centre Hospitalier Universitaire de Sherbrooke 3001, Sherbrooke, Québec, Canada.
authors.forename: Warner M
authors.initials: WM
authors.lastname: Mampuya
authors.forename: David
authors.initials: D
authors.lastname: Frid
authors.forename: Michael
authors.initials: M
authors.lastname: Rocco
authors.forename: Julie
authors.initials: J
authors.lastname: Huang
authors.forename: Danielle M
authors.initials: DM
authors.lastname: Brennan
authors.forename: Stanley L
authors.initials: SL
authors.lastname: Hazen
authors.forename: Leslie
authors.initials: L
authors.lastname: Cho
mesh_terms: D000328:Adult; D000368:Aged; D008078:Cholesterol, LDL / Q000097:blood*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects*; D006949:Hyperlipidemias / Q000188:drug therapy* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D008078:Cholesterol, LDL; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors
references.citation: J Am Coll Cardiol. 2004 Aug 4;44(3):720-32
references.pmid: 15358046
references.citation: J Am Coll Cardiol. 2007 May 1;49(17):1753-62
references.pmid: 17466224
references.citation: J Am Coll Cardiol. 2002 Aug 7;40(3):567-72
references.pmid: 12142128
references.citation: Circulation. 2006 Dec 19;114(25):2788-97
references.pmid: 17159064
references.citation: Curr Med Res Opin. 2008 Nov;24(11):3059-62
references.pmid: 18826752
references.citation: Am J Cardiol. 2008 Jun 15;101(12):1747-8
references.pmid: 18549851
references.citation: Am Heart J. 2002 Oct;144(4):674-7
references.pmid: 12360164
references.citation: J Clin Lipidol. 2011 Jul-Aug;5(4):308-15
references.pmid: 21784377
references.citation: Am J Cardiol. 2007 Jan 15;99(2):291
references.pmid: 17223437
references.citation: Pharmacotherapy. 1998 Jul-Aug;18(4):836-9
references.pmid: 9692657
references.citation: Cardiovasc Drugs Ther. 2005 Dec;19(6):403-14
references.pmid: 16453090
references.citation: Am J Cardiol. 2007 Aug 1;100(3):554-5
references.pmid: 17659946
references.citation: Clin Ther. 2006 Jun;28(6):933-42
references.pmid: 16860175
references.citation: Circulation. 2002 Dec 17;106(25):3143-421
references.pmid: 12485966
references.citation: Cleve Clin J Med. 2011 Jun;78(6):393-403
references.pmid: 21632911
references.citation: J Gen Intern Med. 2008 Aug;23(8):1182-6
references.pmid: 18449611
references.citation: Am J Med. 2013 Feb;126(2):99-104
references.pmid: 23331434
references.citation: Am J Cardiol. 1999 Apr 1;83(7):1135-7, A9
references.pmid: 10190536
references.citation: Ann Pharmacother. 2008 Mar;42(3):341-6
references.pmid: 18285559
references.citation: Clin Chem. 1972 Jun;18(6):499-502
references.pmid: 4337382
references.citation: Acta Diabetol. 2006 Nov;43(3):75-8
references.pmid: 17143784
references.citation: Ann Intern Med. 2013 Apr 2;158(7):526-34
references.pmid: 23546564
references.citation: N Engl J Med. 2011 Dec 15;365(24):2250-1
references.pmid: 22085320
references.citation: Curr Pharm Des. 2011 Nov;17(33):3669-89
references.pmid: 22074437
references.citation: Curr Opin Cardiol. 2006 Jul;21(4):400-4
references.pmid: 16755211
references.citation: J Cardiovasc Pharmacol Ther. 2003 Jun;8(2):123-6
references.pmid: 12808485
references.citation: Am J Cardiol. 2009 Feb 1;103(3):393-4
references.pmid: 19166695
references.citation: Am J Cardiol. 2008 Feb 15;101(4):483-5
references.pmid: 18312762
references.citation: Drug Saf. 2000 Sep;23(3):197-213
references.pmid: 11005703