PS1-45: Prevalence of Statin Intolerance in a High Risk Cohort and Management Strategies in Contemporary Cardiology

Abstract

Background/Aims Statins are the mainstay of lipid-lowering therapy in contemporary medicine because of their well-established efficacy for reducing cardiovascular disease (CVD) morbidity and mortality in various at-risk populations. However, as many as 20% of individuals with a clinical indication for statin therapy are unable to take a daily statin due to some degree of intolerance. It is unknown what the most appropriate treatment is for these patients. We analyzed how this cohort of patients at high risk for cardiovascular morbidity and mortality is managed in contemporary cardiology.

Methods Using our electronic health record (EHR) database, EPIC software, we identified patients who were older than 18 years with a high-risk indication for statin therapy; known coronary artery disease, known atherosclerotic disease, or diabetes. We identified those patients as statin intolerant if they had no recent history of statin use and were documented to have been prescribed at least one statin in the past.

Results A total of 63,624 high-risk patients met the eligibility criteria, with over 85% (54,536 patients) receiving a statin, although 5.1% (2,794 patients) were taking a ubiquinol supplement. Of the 9,088 (14.3%) statin intolerant patients, ~1/3 had tried 2 or more statins. Only 21% (1879 patients) were identified as having a statin allergy and 48 (0.5%) had a history of rhabdomyolysis with statin use. We found that 4448 patients (48.9%) were on alternative lipid-lowering medications with omega 3 supplements being most common (28.3%, 1257 patients) followed by ezetimibe (17.2%, 764 patients), fibrates (10.8%, 482 patients), and niacin (5.2%, 229 patients).

Conclusions Management of statin intolerance in a high-risk contemporary cohort of patients is challenging for modern-day health care providers. No strategies have been studied to assess long-term outcomes leading to marked variability in management. A clinical trial is warranted to assess the best treatment approach for this subset of the population who are at high risk for adverse cardiac events.

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