title: Statin Intolerance and Risk of Coronary Heart Events and All-Cause Mortality Following Myocardial Infarction.
abstract: BACKGROUND
  Many patients report adverse reactions to, and may not tolerate, statin therapy. These patients may be at increased risk for coronary heart disease (CHD) events and mortality.
  
  
  OBJECTIVE
  This study evaluated the risk for recurrent myocardial infarction (MI), CHD events, and all-cause mortality in Medicare beneficiaries with statin intolerance and in those with high adherence to statin therapy.
  
  
  METHODS
  We studied 105,329 Medicare beneficiaries who began a moderate- or high-intensity statin dosage after hospitalization for MI between 2007 and 2013. Statin intolerance was defined as down-titrating statins and initiating ezetimibe therapy, switching from statins to ezetimibe monotherapy, having International Classification of Diseases, 9th revision, diagnostic codes for rhabdomyolysis or an antihyperlipidemic adverse event, followed by statin down-titration or discontinuation, or switching between ≥3 types of statins within 1 year after initiation. High statin adherence over the year following hospital discharge was defined as proportion of days covered ≥80%. Recurrent MI, CHD events (recurrent MI or a coronary revascularization procedure), and mortality were identified from 1 year after hospital discharge through December 2014.
  
  
  RESULTS
  Overall, 1,741 patients (1.65%) had statin intolerance, and 55,567 patients (52.8%) had high statin adherence. Over a median of 1.9 to 2.3 years of follow-up, there were 4,450 recurrent MIs, 6,250 CHD events, and 14,311 deaths. Compared to beneficiaries with high statin adherence, statin intolerance was associated with a 36% higher rate of recurrent MI (41.1 vs. 30.1 per 1,000 person-years, respectively), a 43% higher rate of CHD events (62.5 vs. 43.8 per 1,000 person-years, respectively), and a 15% lower rate of all-cause mortality (79.9 vs. 94.2 per 1,000 person-years, respectively). The multivariate-adjusted hazard ratios (HR) comparing beneficiaries with statin intolerance versus those with high statin adherence were 1.50 (95% confidence interval [CI]: 1.30 to 1.73) for recurrent MI, 1.51 (95% CI: 1.34 to 1.70) for CHD events, and 0.96 (95% CI: 0.87 to 1.06) for all-cause mortality.
  
  
  CONCLUSIONS
  Statin intolerance was associated with an increased risk for recurrent MI and CHD events but not all-cause mortality.
authors.affiliation: Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama; Department of Functional Sciences, University of Medicine and Pharmacy Victor Babes Timisoara, Romania.
authors.forename: Maria-Corina
authors.initials: MC
authors.lastname: Serban
authors.affiliation: Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Lisandro D
authors.initials: LD
authors.lastname: Colantonio
authors.affiliation: Center for Observational Research, Amgen, Inc., Thousand Oaks, California.
authors.forename: Angelika D
authors.initials: AD
authors.lastname: Manthripragada
authors.affiliation: Center for Observational Research, Amgen, Inc., Thousand Oaks, California.
authors.forename: Keri L
authors.initials: KL
authors.lastname: Monda
authors.affiliation: Department of Medicine, Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Vera A
authors.initials: VA
authors.lastname: Bittner
authors.affiliation: Department of Hypertension, Medical University of Lodz, Lodz, Poland.
authors.forename: Maciej
authors.initials: M
authors.lastname: Banach
authors.affiliation: Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Ligong
authors.initials: L
authors.lastname: Chen
authors.affiliation: Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Lei
authors.initials: L
authors.lastname: Huang
authors.affiliation: Esperion Therapeutics, Ann Arbor, Michigan.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Dent
authors.affiliation: Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Shia T
authors.initials: ST
authors.lastname: Kent
authors.affiliation: Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama. Electronic address: pmuntner@uab.edu.
authors.forename: Paul
authors.initials: P
authors.lastname: Muntner
authors.affiliation: Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Robert S
authors.initials: RS
authors.lastname: Rosenson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D008297:Male; D055118:Medication Adherence; D009203:Myocardial Infarction / Q000401:mortality / Q000517:prevention & control*; D012189:Retrospective Studies; D055502:Secondary Prevention; D014481:United States / Q000453:epidemiology
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors
keywords: coronary heart disease; mortality; myocardial infarction; statins