title: Clinical and economic consequences of statin intolerance in the United States: Results from an integrated health system.
abstract: Although statins are considered safe and effective, they have been associated with statin intolerance (SI) in clinical and observational studies.
  
  
  
  The objective of this study was to describe the clinical and economic consequences of SI through comparison of an SI cohort of patients with matched controls.
  
  
  
  This study used data extracted from an integrated health system's electronic health records from 2008 to 2014. Adults with SI were matched to controls using a propensity score. Patients were hierarchically classified into 6 mutually exclusive cardiovascular (CV)-risk categories: recent acute coronary syndrome (ACS; ≤12 months preindex), coronary heart disease, ischemic stroke, peripheral artery disease, diabetes, or primary prevention. The study endpoints, low-density lipoprotein cholesterol (LDL-C) goal attainment, medical costs, and time to first CV event were compared using conditional logistic regression, generalized linear, and Cox proportional hazards models, respectively.
  
  
  
  Patients with SI (n = 5190) were matched with controls (n = 15,570). Patients with SI incurred higher medical costs and were less likely to reach LDL-C goals than controls. Patients with SI were at higher risk for revascularization procedures in all CV risk categories except ACS, and those in the diabetes risk category were at higher risk for any CV event. There was a lower risk of all-cause death among patients with SI.
  
  
  
  Patients with SI were less likely to reach LDL-C goals, incurred higher health care costs, and experienced a higher risk for nonfatal CV events than patients without SI. Alternative management strategies are needed to better treat high CV risk patients.
authors.affiliation: Geisinger Health System, Danville, PA, USA. Electronic address: jhgraham1@geisinger.edu.
authors.forename: Jove H
authors.initials: JH
authors.lastname: Graham
authors.affiliation: Regeneron Pharmaceuticals, Inc, Tarrytown, NY, USA.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Sanchez
authors.affiliation: University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Saseen
authors.affiliation: Sanofi US, Bridgewater, NJ, USA.
authors.forename: Usha G
authors.initials: UG
authors.lastname: Mallya
authors.affiliation: Sanofi US, Bridgewater, NJ, USA.
authors.forename: Mary P
authors.initials: MP
authors.lastname: Panaccio
authors.affiliation: Geisinger Health System, Danville, PA, USA.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Evans
mesh_terms: D002318:Cardiovascular Diseases / Q000097:blood / Q000188:drug therapy / Q000191:economics; D016022:Case-Control Studies; D008078:Cholesterol, LDL / Q000097:blood; D015331:Cohort Studies; D003695:Delivery of Health Care; D057286:Electronic Health Records / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D008078:Cholesterol, LDL; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors
keywords: Health care costs; High CV risk; Integrated health system; LDL-C; Statin intolerance