Highlights
- •From published controlled studies of statins, more than 75 patients need treatment with statin therapy for 10 years to experience a minor reversible side effect attributable to the statin.
- •The number of patients needing statin treatment to prevent one atherosclerotic cardiovascular disease (ASCVD) event over 10 years is between 3 and 61 depending on ASCVD risk and pre-treatment LDL cholesterol.
- •Statin adverse events of equivalent severity to ASCVD occurr with a frequency of <0.133% over 10 years eroding statin benefit minimally.
- •The most severe complication of SI is discontinuation of effective cholesterol-lowering treatment in patients who might otherwise benefit.
- •When statin intolerance (SI) is encountered, re-challenge is recommended with a statin with the potential to reach the appropriate therapeutic target.
Abstract
Background and aims
There is disquiet about statin effectiveness and side effects in both the medical
and lay media.
Methods
We searched the literature for reports on the incidence of statin intolerance (SI)
in which control rates of similar events were also recorded. The number of people
who must receive treatment (NNT) to prevent one atherosclerotic cardiovascular disease
(ASCVD) event at 5–50% 10-year risk and LDL cholesterol 2–7 mmol/l was compared with
the number of those who would experience harm attributable to statin (NNH). Using
a similar method, the effectiveness of various strategies to overcome SI in preventing
CVD was then compared.
Results
Observational studies with non-randomised control groups report higher rates of statin
adverse events than randomised trials. Overall, at least 75 patients must be treated
for one to experience a side effect. In contrast, the NNT to prevent one ASCVD event
with statins as monotherapy or in combination with other cholesterol-lowering medications
to achieve at least 50% decrease in LDL cholesterol and <1.8 mmol/l was between 3
and 61, depending on risk and LDL cholesterol. NNH for adverse events of severity
equivalent to ASCVD was >750 (<0.1333%).
When SI is encountered, the most effective current management for most patients in
terms of ASCVD reduction is to rechallenge with low dose potent statin and then up-titrate
until the cholesterol target has been achieved with, if necessary, the addition of
ezetimibe 10 mg daily.
Conclusions
The most severe complication of SI is discontinuation of effective cholesterol-lowering
treatment in patients who, by virtue of their CVD risk and cholesterol level, might
otherwise benefit.
Graphical abstract
Graphical Abstract
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Article Info
Publication History
Published online: July 05, 2020
Accepted:
June 24,
2020
Received in revised form:
May 3,
2020
Received:
January 28,
2020
Identification
Copyright
© 2020 Published by Elsevier B.V.
