Statin intolerance occurs when a person experiences side effects from statin use. Certain risk factors may raise your chances of developing statin intolerance.
One in every two patients stops taking statins, reduces the dose, or takes them occasionally since they fear the cholesterol-lowering drugs induce muscle pain and other side effects.
Now, a recent study of nearly four million patients has determined that the true global rate of statin intolerance is between 6% and 10%.
The authors of the study, which was published in the European Heart Journal, claim that their findings suggest that statin intolerance is over-diagnosed and over-diagnosed, putting patients at risk for heart and blood vessel disorders, including mortality, as a result of high cholesterol levels.
There is compelling and convincing evidence that statin therapy has a major impact on preventing and dying from cardiovascular disease. Statins are one of the most often recommended medications. However, it has remained unclear how many people are actually intolerant of the medicine until recently, with reports ranging from 5 to 50 percent based on research, randomized controlled trials, and databases.
Professor Maciej Banach headed a team of researchers who conducted a meta-analysis of 176 studies including 4,143,517 patients from all over the world. The goal was to determine the overall prevalence of statin intolerance as well as the prevalence of statin intolerance according to various diagnostic criteria. They also wanted to figure out what factors make people more susceptible to statin intolerance.
They discovered that the overall prevalence was 9.1%. The prevalence was considerably lower when the National Lipid Association, the ILEP, and the European Atherosclerosis Society used diagnostic criteria: 7%, 6.7%, and 5.9%, respectively.
According to the lead author: “These results show that in most cases statin intolerance is over-estimated and over-diagnosed, and they mean that around 93% of patients on statin therapy can be treated effectively, with very good tolerability and without any safety issues.
“Our findings mean that we should evaluate patients’ symptoms very carefully, firstly to see whether symptoms are indeed caused by statins, and secondly, to evaluate whether it might be patients’ perceptions that statins are harmful – so called nocebo or drucebo effect – which could be responsible for more than 50% of all symptoms, rather than the drug itself.”
People who were older, female, of Black or Asian ancestry, obese, or had diabetes, underactive thyroid glands, or chronic liver or kidney failure were also more likely to be statin intolerant, according to the study.
Furthermore, statin resistance was linked to medications that manage irregular heartbeat (arrhythmia), calcium channel blockers (commonly used for chest discomfort and high blood pressure), alcohol usage, and higher statin doses. In these groups, the increased risk of statin intolerance ranged from 22% (heavy alcohol intake) to 48% (female).
The researchers recognize that their meta-analysis has certain limitations, such as discrepancies in patients included in different trials and a lack of information on alcohol intake and exercise kinds. However, because of the vast number of studies and patients included in the study, they have attempted to limit the possibility of bias from these.
“Most cases of statin intolerance observed in clinical practice are associated with effects caused by patients’ misconceptions about the side effects of statins or may be due to other reasons. Therefore, we should carefully evaluate symptoms, assessing in detail patients’ medical histories, when the symptoms appeared, specific details of pain, other medications the patients are taking, and other conditions and risk factors. Then we will see that statins can be used safely in most patients, which is critically important for reducing their cholesterol levels and preventing heart and blood vessel diseases and death,” concluded the author.
Source: 10.1093/eurheartj/ehac015
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