SAT-258 - Statin Intolerance Management and Outcomes: Real World Data

Statin intolerance poses a major barrier to achieving LDL-C targets for the prevention of atherosclerotic cardiovascular disease (ASCVD). We conducted a retrospective chart review to evaluate management strategies and outcomes of patients referred to our institution’s lipid clinic for statin intolerance, comparing those evaluated in clinic between January 1, 2018 and January 1, 2023 (clinic cohort) with those referred but never seen (non-clinic cohort). Outcomes were further stratified by primary versus secondary prevention. LDL-C goals were defined as < 100 mg/dL for primary prevention and < 70 mg/dL for secondary prevention.

Our cohort included 453 patients at high ASCVD risk given the mean age was 66 years, 90% were male, 42% had diabetes mellitus, 52% were current or former smokers, 45% had established ASCVD, and 44% were referred for primary prevention with intermediate to high ASCVD risk (10 year risk of at least 7.5% based on the ACC ASCVD Risk Estimator). Prior to referral, the most commonly trialed statins were simvastatin (60%), rosuvastatin (52%), pravastatin (39%), and atorvastatin (24%) with myalgias being the most frequently reported adverse effect (58%).

288/453 (64%) patients made up the clinic cohort, out of which 188/288 (65%) were rechallenged with a statin at their first visit. Statin rechallenge most frequently involved rosuvastatin (58%), typically at 2.5 mg less than every other day or 10 mg daily, followed by pitavastatin (19%), most often at 1 mg daily, and pravastatin (11%), commonly at 20 mg daily. Among patients rechallenged with a statin, 62/188 (33%) exhibited tolerability for at least one year.

The frequency of LDL-C goal attainment was higher in the clinic cohort compared to the non-clinic cohort (133/288, 46% vs. 38/165, 23%; p < 0.0001). Furthermore, 60/133 (45%) patients in the clinic cohort reached their goal with the regimen prescribed at their initial visit. While the proportion of patients who achieved but could not sustain their LDL-C goal did not differ significantly between the clinic and non-clinic cohorts (79/133, 59% vs. 17/38, 45%; p 0.1082), it is apparent that ongoing follow up is imperative.

During the study period, major adverse cardiovascular events (MACE) occurred in 15% of patients in both cohorts and was higher in the secondary prevention group than the primary prevention group in both cohorts (clinic: 22% vs. 9%, p 0.0020; non-clinic: 23% vs. 9%, p 0.0114). Within the clinic cohort, 6/54 (11%) patients who reached and maintained their LDL-C goal had a MACE compared to 18/79 (23%) patients who met then exceeded their target (p 0.0856).

Overall, 73/133 (55%) of the clinic cohort achieved their LDL-C goal with statin therapy alone or combined with ezetimibe, suggesting patients with reported statin intolerance can actually tolerate rechallenge with an alternative statin or dosing regimen without needing expensive second-line therapies.

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