title: Hypothyroidism as a risk factor for statin intolerance.
abstract: BACKGROUND
  Three-hydroxy-3-methylglutaryl-coenzyme A reductase inhibitors (statins) are one of the most commonly prescribed classes of medications because of their proven cardiovascular benefits. However, statin intolerance occurs in 5% to 20% of patients. Understanding the basis for statin intolerance remains a key issue in preventive medicine.
  
  
  OBJECTIVE
  To evaluate the association of statin intolerance with hypothyroidism in a large integrated health care system, including its sex-specific relationship and subsequent statin rechallenge and prescription history.
  
  
  METHODS
  The Intermountain Healthcare electronic medical record database identified patients (n = 2686; males = 1276, females = 1410) with a documentation of intolerance ("allergy") to at least 1 statin. Age and sex similar controls (n = 8103; males = 3892, females = 4211) were identified among patients prescribed statins without documented intolerance. Patients were evaluated for a history of hypothyroidism, development of hypothyroidism, and statin prescription history up to 5 years of follow-up.
  
  
  RESULTS
  A total of 30.2% patients (210 males, 16.5%; 602 females, 42.7%) with statin intolerance had a history of hypothyroidism compared with 21.5% of statin-tolerant patients (475 males, 12.2%; 1266 females, 30.1%), for an odds ratio (OR) in the total population of 1.49 (95% confidence interval [CI] 1.34-1.65; P < .0001); in males, OR was 1.29 (CI 1.07-1.55; P = .001); in females, OR was 1.60 (CI 1.41-1.82; P < .0001). During follow-up, patients with statin intolerance and hypothyroidism were less likely to be on a statin than their statin-intolerant counterparts without hypothyroidism (hazard ratio 0.84; 95% CI 0.75-0.94; P = .002).
  
  
  CONCLUSIONS
  Hypothyroidism is more prevalent in those with statin intolerance, both in males and, especially, in females. People with hypothyroidism are less likely to have a prescription for a statin at follow-up than those without hypothyroidism.
authors.affiliation: Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA. Electronic address: Craig.Robison@hsc.utah.edu.
authors.forename: Craig D
authors.initials: CD
authors.lastname: Robison
authors.affiliation: Intermountain Heart Institute, Intermountain Medical Center, Salt Lake City, UT, USA.
authors.forename: Tami L
authors.initials: TL
authors.lastname: Bair
authors.affiliation: Intermountain Heart Institute, Intermountain Medical Center, Salt Lake City, UT, USA; Division of Cardiology, University of Utah School of Medicine, Salt Lake City, UT, USA.
authors.forename: Benjamin D
authors.initials: BD
authors.lastname: Horne
authors.affiliation: Intermountain Heart Institute, Intermountain Medical Center, Salt Lake City, UT, USA.
authors.forename: Ray O
authors.initials: RO
authors.lastname: McCubrey
authors.affiliation: Intermountain Heart Institute, Intermountain Medical Center, Salt Lake City, UT, USA.
authors.forename: Donald L
authors.initials: DL
authors.lastname: Lappe
authors.affiliation: Intermountain Heart Institute, Intermountain Medical Center, Salt Lake City, UT, USA; Division of Cardiology, University of Utah School of Medicine, Salt Lake City, UT, USA.
authors.forename: Joseph B
authors.initials: JB
authors.lastname: Muhlestein
authors.affiliation: Intermountain Heart Institute, Intermountain Medical Center, Salt Lake City, UT, USA; Division of Cardiology, University of Utah School of Medicine, Salt Lake City, UT, USA.
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Anderson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004342:Drug Hypersensitivity / Q000453:epidemiology*; D057286:Electronic Health Records; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000276:immunology / Q000627:therapeutic use; D007037:Hypothyroidism / Q000188:drug therapy / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012306:Risk; D012737:Sex Factors; D014481:United States
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors
keywords: Dyslipidemia; Epidemiology; HMG-COA reductase inhibitors; Statin intolerance; Statin rechallenge; Statins Hypothyroidism; Subclinical hypothyroidism