From the Guidelines
Discontinuation of Statin Therapy
Patients who achieve normal cholesterol levels while on statin therapy, such as atorvastatin (Lipitor) 20-40mg daily or simvastatin (Zocor) 20-80mg daily, for a duration of at least 6-12 months, may be considered for discontinuation or dose reduction. However, discontinuation of statin therapy is generally not recommended for patients with established cardiovascular disease or those at high risk of cardiovascular events, as the benefits of continued statin therapy in reducing cardiovascular risk outweigh the potential risks 1.
Key Considerations
- Established Cardiovascular Disease: Discontinuation of statin therapy is not recommended for patients with established cardiovascular disease, as it may increase the risk of cardiovascular events 1.
- High-Risk Patients: Patients at high risk of cardiovascular events should continue statin therapy, as the benefits of treatment outweigh the potential risks 1.
- Monitoring: Patients without established cardiovascular disease who are considered for statin discontinuation or dose reduction should be closely monitored for changes in cholesterol levels and cardiovascular risk factors 1.
Recommendations
- Statin Therapy: High-intensity statin therapy should be initiated or continued as first-line therapy in patients with clinical atherosclerotic cardiovascular disease (ASCVD), unless contraindicated 1.
- Dose Reduction: If muscle symptoms develop during statin therapy, the statin should be discontinued until the symptoms can be evaluated, and a lower dose or a different statin may be considered 1.
- Close Monitoring: Patients with statin-associated muscle symptoms should be closely monitored, and the statin should be discontinued if the symptoms persist or worsen 1.
From the Research
Statin Discontinuation and Lipid Profiles
- The decision to discontinue statin therapy should be carefully considered, as available data outside of specific patient populations do not support discontinuation 2.
- National guidelines highlight the lack of benefit seen with statin therapy in certain patient groups, such as those with chronic kidney disease receiving dialysis, heart failure with reduced ejection fraction, and patients greater than 75 years of age without atherosclerotic cardiovascular disease 2.
- Recent studies support an association between statin discontinuation and increased risk of myocardial infarction and cardiovascular death 2.
Benefits of Statin Therapy
- Statin therapy has been shown to significantly reduce the relative risk of cardiovascular disease by 24-37%, regardless of age, sex, prior history of coronary heart disease, or other co-morbid conditions 3.
- Studies have demonstrated that statin treatment can be effective in people whose LDL-C is not considered elevated under current guidelines, and that more intensive lipid-lowering regimens can provide additional clinical benefits 3, 4.
- The benefits of statin therapy far outweigh any real or perceived risks, with overwhelming evidence suggesting that statins are safe and effective in both primary and secondary prevention of cardiovascular disease 5.
LDL-C Targets and Statin Therapy
- Current guidelines recommend an LDL cholesterol target of 70 mg/dL for patients at high or very high risk, with evidence suggesting that very low LDL cholesterol levels are associated with a very low risk of cardiovascular disease 6.
- Analyses of randomized clinical trials have shown a greater benefit in reducing the risk of cardiovascular disease among those with very low achieved LDL levels, without an increase in adverse events 6.
- High-intensity statin therapy is associated with a higher rate of transaminase elevations, but no hepatic failure, a very small risk of myopathy, and an increased risk of developing diabetes, although the small increase in the risk of developing diabetes is much smaller than the marked lowering of cardiovascular risk 6, 4.