Open AccessDiscussion around statin discontinuation in older adults and patients with wasting diseases
Author(s) -
Banach Maciej,
Serban MariaCorina
Publication year - 2016
Publication title -
journal of cachexia, sarcopenia and muscle
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.803
H-Index - 66
eISSN - 2190-6009
pISSN - 2190-5991
DOI - 10.1002/jcsm.12109
Subject(s) - ezetimibe , simvastatin , medicine , discontinuation , statin , evolocumab , pcsk9 , adverse effect , clinical trial , stroke (engine) , myocardial infarction , gastroenterology , cholesterol , lipoprotein , ldl receptor , mechanical engineering , apolipoprotein a1 , engineering
Statins are usually selected as the first-line therapy to lower plasma levels of low-density lipoprotein cholesterol (LDL-C) and cardiovascular disease (CVD) morbidity and mortality. They reduce the risk of myocardial infarction, stroke and CVD mortality by about 25–30%. That is one of the reasons why all current clinical guidelines ‘virtually mandate’ lifetime use of statins once they are started, thus becoming a challenge for the patients due to their possible side effects. Furthermore, there has been recently a tendency towards maximizing the strength of statin treatment, sometimes with greater doses or potent forms. The IMProved Reduction of Outcomes: Vytorin Efficacy International Trial showed that the combination with ezetimibe/simvastatin 10mg/40mg let to an absolute 2.0% reduction (relative risk reduction: 6.4%) of the risk of CV events in contrast to simvastatin 40mg alone. The trial also demonstrated that the patients with obtained very low LDL-C levels <30mg/dL experienced no discrepancies in adverse effects than those with higher LDL-C levels. ODYSSEY LONG-TERM and the Open-Label Study of Long-term Evaluation against LDL-C trials with proprotein convertase subtilisin/kexin type 9 inhibitors also supported the hypothesis ‘the lower the better’ for LDL-C levels, generating more arguments for lower LDL-C targets <50mg/dL (1.3mmol/L), in contrast with the current targets <70mg/dL (1.8mmol/L) for patients at the highest risk. These results are in line with the 2013 American College of Cardiology/American Heart Association guidelines, which advise the use of high-intensity statin therapy and extend its use to more categories susceptible to CVD. Taking into account still poor to moderate statin therapy control in the high-risk and highest-risk patients (even 50% of patients are non-adherent to therapy after 2 years), as well as the aforementioned data, more intense targets seem to be very important; however, on the other hand, high-intensity statin therapy might also increase the risk of statin-related side effects and statin discontinuation rate due to this fact.