From the Guidelines
Statin therapy should not be routinely held during hospitalization for conditions like lactic acidosis unless there's a clear contraindication, as the benefits of continuing statin therapy often outweigh the risks, especially considering the importance of maintaining guideline-directed medical therapy (GDMT) in patients with heart failure or those at risk for cardiovascular events. The decision to hold or continue statin therapy should be individualized, taking into account the patient's specific clinical condition, the severity of the lactic acidosis, and the potential impact on cardiovascular risk. According to the 2022 AHA/ACC/HFSA guideline for the management of heart failure 1, preexisting GDMT, which may include statins, should be continued and optimized during hospitalization unless contraindicated, emphasizing the importance of maintaining these therapies to improve outcomes.
When considering the management of patients with acute conditions such as lactic acidosis, it's crucial to prioritize treatments that address the immediate cause of the condition while also considering the long-term benefits of therapies like statins. The 2013 ACCF/AHA focused update incorporated into the ACCF/AHA 2007 guidelines for the management of patients with unstable angina/non-ST-elevation myocardial infarction 1 supports the initiation of lipid-lowering therapy before hospital discharge, highlighting the safety and efficacy of early treatment, as well as the benefits of improved long-term compliance.
Key considerations in the decision to hold or continue statin therapy include:
- The severity of the lactic acidosis and its potential to be exacerbated by statin therapy
- The patient's underlying cardiovascular risk and the potential benefits of continued statin therapy
- The presence of any contraindications to statin use
- The overall clinical stability of the patient and the ability to safely manage potential side effects of statin therapy
In general, the approach should prioritize the continuation of statin therapy whenever possible, given its established benefits in reducing cardiovascular morbidity and mortality, unless specific circumstances dictate otherwise. This approach aligns with guidelines that emphasize the importance of maintaining GDMT in hospitalized patients, unless contraindicated, to optimize outcomes 1.
From the Research
Holding Statin for Hospitalization Lactic Acidosis
- Lactic acidosis is a serious metabolic condition that can occur in hospitalized patients, often as a result of an underlying pathogenic process 2.
- The use of statins has been linked to the development of lactic acidosis in some cases, with one study suggesting that statin-induced lactic acidosis may be caused by a mitochondrial defect resulting from the inhibition of ubiquinone and thiamine deficiency 3.
- In patients with lactic acidosis, it is essential to eliminate the underlying cause of the condition, and in some cases, this may involve discontinuing certain medications, including statins 4, 5.
- The management of lactic acidosis typically involves supportive care, and in some cases, the use of exogenous bicarbonate therapy or other treatments may be necessary 4, 5.
- The decision to hold statins in patients with lactic acidosis should be made on a case-by-case basis, taking into account the individual patient's condition and medical history 3.
- It is crucial to monitor patients with lactic acidosis closely, as the condition can be life-threatening, and prompt treatment is essential to prevent serious complications 2, 6.