statin

It was bound to happen now that most statins are generic, the adverse effects are going to be revealed. Apparently high-dose statins increase the likelihood of a subsequent osteoporosis diagnosis. Even though this is a cohort study, not an RCT, the dose response relationship makes the results more credible. James W. Mold, MD, MPH

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OBJECTIVE:

Whether HMG-CoA-reductase inhibition, the main mechanism of statins, plays a role in the pathogenesis of osteoporosis, is not entirely known so far. Consequently, this study was set out to investigate the relationship of different kinds and dosages of statins with osteoporosis, hypothesising that the inhibition of the synthesis of cholesterol could influence sex-hormones and therefore the diagnosis of osteoporosis.

METHODS:

Medical claims data of all Austrians from 2006 to 2007 was used to identify all patients treated with statins to compute their daily defined dose averages of six different types of statins. We applied multiple logistic regression to analyse the dose-dependent risks of being diagnosed with osteoporosis for each statin individually.

RESULTS:

In the general study population, statin treatment was associated with an overrepresentation of diagnosed osteoporosis compared with controls (OR: 3.62, 95% CI 3.55 to 3.69, p<0.01). There was a highly non-trivial dependence of statin dosage with the ORs of osteoporosis. Osteoporosis was underrepresented in low-dose statin treatment (0-10 mg per day), including lovastatin (OR: 0.39, CI 0.18 to 0.84, p<0.05), pravastatin (OR: 0.68, 95% CI 0.52 to 0.89, p<0.01), simvastatin (OR: 0.70, 95% CI 0.56 to 0.86, p<0.01) and rosuvastatin (OR: 0.69, 95% CI 0.55 to 0.87, p<0.01). However, the exceeding of the 40 mg threshold for simvastatin (OR: 1.64, 95% CI 1.31 to 2.07, p<0.01), and the exceeding of a 20 mg threshold for atorvastatin (OR: 1.78, 95% CI 1.41 to 2.23, p<0.01) and for rosuvastatin (OR: 2.04, 95% CI 1.31 to 3.18, p<0.01) was related to an overrepresentation of osteoporosis.

CONCLUSION:

Our results show that the diagnosis of osteoporosis in statin-treated patients is dose-dependent. Thus, osteoporosis is underrepresented in low-dose and overrepresented in high-dose statin treatment, demonstrating the importance of future studies' taking dose-dependency into account when investigating the relationship between statins and osteoporosis.

Author/s:

Leutner, M., Matzhold, C., Bellach, L., Deischinger, C., Harreiter, J., Thurner, S., Klimek, P., Kautzky-Willer, A.

Prescribing Statins to Reduce Cardiovascular Disease – Ten Common Misconceptions

Jeffrey Wilson — Tue, 12 Mar 2019 19:51:43 +0000

Date Added:

March 12, 2019

Journal/Publication:

The American Journal of Medicine

Publisher:

Elsevier

Publication Date:

March 2, 2019

URL:

Prescribing Statins to Reduce Cardiovascular Disease - Ten Common Misconceptions

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1016/j.amjmed.2019.01.042

Keywords

statins

statin

statin therapy

PMID (1):

30851261

MeSH

Hydroxymethylglutaryl-CoA Reductase Inhibitors

Ten misconceptions about statin therapy debunked.

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Statins (HMG-CoA reductase inhibitors) are one of the most widely prescribed medications in the world. However, their use in patients is often inappropriate because these medications have some unique properties not shared with other pharmaceuticals. This Commentary lists ten common misconceptions concerning statins and provides documentation supporting statin's unique characteristics.

Author/s:

Schade, David S., Shey, Lynda, Eaton, R. Phillip

Cholesterol Management in Primary Care

Jeffrey Wilson — Wed, 05 Sep 2018 15:42:28 +0000

Date Added:

September 5, 2018

Journal/Publication:

Healthy Hearts for Oklahoma

Publisher:

Agency for Healthcare Research and Quality

Type:

Clinical Decision Aids

Format:

Slides

Keywords

MeSH

Hydroxymethylglutaryl-CoA Reductase Inhibitors

cholesterol

primary prevention

This is the decision aid for statin use developed for the Healthy Hearts for OK Project.

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Patients with existing disease or major risk factors should be prescribed statins unless contraindicated.

Efficacy and safety of statin therapy in older people: a meta-analysis of individual participant data from 28 randomised controlled trials

Tracy Ashby — Sun, 18 Feb 2018 06:00:00 +0000

Date Added:

February 18, 2019

Journal/Publication:

The Lancet

Publisher:

Elsevier Inc.

Publication Date:

February 2, 2019

Issue:

10170

Volume:

393

Pages:

407-415

URL:

Efficacy and safety of statin therapy in older people: a meta-analysis of individual participant data from 28 randomised controlled trials

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1016/S0140-6736(18)31942-1

Keywords

statin

statin therapy

cholesterol, LDL

PMID (1):

30712900

MeSH

Hydroxymethylglutaryl-CoA Reductase Inhibitors

cholesterol

cholesterol, LDL

risk reduction behavior

Statins appear to work just as well in patients over the age of 75 as they do in younger patients.

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BACKGROUND:

Statin therapy has been shown to reduce major vascular events and vascular mortality in a wide range of individuals, but there is uncertainty about its efficacy and safetyamong older people. We undertook a meta-analysis of data from all large statin trials to compare the effects of statin therapy at different ages.

METHODS:

In this meta-analysis, randomised trials of statin therapy were eligible if they aimed to recruit at least 1000 participants with a scheduled treatment duration of at least 2 years. We analysed individual participant data from 22 trials (n=134 537) and detailed summary data from one trial (n=12 705) of statin therapy versus control, plus individual participant data from five trials of more intensive versus less intensive statin therapy (n=39 612). We subdivided participants into six age groups (55 years or younger, 56-60 years, 61-65 years, 66-70 years, 71-75 years, and older than 75 years). We estimated effects on major vascular events (ie, major coronary events, strokes, and coronary revascularisations), cause-specific mortality, and cancer incidence as the rate ratio (RR) per 1·0 mmol/L reduction in LDL cholesterol. We compared proportional risk reductions in different age subgroups by use of standard χ2 tests for heterogeneity when there were two groups, or trend when there were more than two groups.

FINDINGS:

14 483 (8%) of 186 854 participants in the 28 trials were older than 75 years at randomisation, and the median follow-up duration was 4·9 years. Overall, statin therapy or a more intensive statin regimen produced a 21% (RR 0·79, 95% CI 0·77-0·81) proportional reduction in major vascular events per 1·0 mmol/L reduction in LDL cholesterol. We observed a significant reduction in major vascular events in all age groups. Although proportional reductions in major vascular events diminished slightly with age, this trend was not statistically significant (ptrend=0·06). Overall, statin or more intensive therapy yielded a 24% (RR 0·76, 95% CI 0·73-0·79) proportional reduction in major coronary events per 1·0 mmol/L reduction in LDL cholesterol, and with increasing age, we observed a trend towards smaller proportional risk reductions in major coronary events (ptrend=0·009). We observed a 25% (RR 0·75, 95% CI 0·73-0·78) proportional reduction in the risk of coronary revascularisation procedures with statin therapy or a more intensive statin regimen per 1·0 mmol/L lower LDL cholesterol, which did not differ significantly across age groups (ptrend=0·6). Similarly, the proportional reductions in stroke of any type (RR 0·84, 95% CI 0·80-0·89) did not differ significantly across age groups (ptrend=0·7). After exclusion of four trials which enrolled only patients with heart failure or undergoing renal dialysis (among whom statin therapy has not been shown to be effective), the trend to smaller proportional risk reductions with increasing age persisted for major coronary events (ptrend=0·01), and remained non-significant for major vascular events (ptrend=0·3). The proportional reduction in major vascular events was similar, irrespective of age, among patients with pre-existing vascular disease (ptrend=0·2), but appeared smaller among older than among younger individuals not known to have vascular disease (ptrend=0·05). We found a 12% (RR 0·88, 95% CI 0·85-0·91) proportional reduction in vascular mortality per 1·0 mmol/L reduction in LDL cholesterol, with a trend towards smaller proportional reductions with older age (ptrend=0·004), but this trend did not persist after exclusion of the heart failure or dialysis trials (ptrend=0·2). Statin therapy had no effect at any age on non-vascular mortality, cancer death, or cancer incidence.

INTERPRETATION:

Statin therapy produces significant reductions in major vascular events irrespective of age, but there is less direct evidence of benefit among patients older than 75 years who do not already have evidence of occlusive vascular disease. This limitation is now being addressed by further trials.

FUNDING:

Australian National Health and Medical Research Council, National Institute for Health Research Oxford Biomedical Research Centre, UK Medical Research Council, and British Heart Foundation.

Author/s:

Cholesterol Treatment Trialists' Collaboration