Predictors of a successful statin reattempt after an adverse reaction.

BACKGROUND: Many patients can tolerate statin therapy after an adverse reaction. However, optimal patient selection criteria and methods of reattempting statin therapy after an adverse reaction are unknown.

OBJECTIVE: To identify patient and treatment characteristics associated with a successful statin reattempt after an adverse reaction.

METHODS: We retrospectively studied adults treated in primary care practices affiliated with 2 academic medical centers between 2000 and 2012 who reattempted statin therapy after an adverse reaction. Statin reattempts were considered successful if the patient had at least 2 statin prescriptions after discontinuation of the original statin, and had an active electronic medical record statin record at 2 years after the adverse reaction.

RESULTS: Among 6196 patients included in the study, 4536 (73.2%) successfully reattempted statin therapy. In multivariable analysis, history of coronary artery disease, stroke, or diabetes (odds ratio [OR] 1.195; P = .008) and reattempted treatment with a different statin (OR 1.463; P < .0001) were associated with greater odds of a successful reattempt. Adverse reaction during the first year after statin initiation (OR 0.721; P < .0001) or myalgia or myopathy (OR 0.807; P = .001) as well as history of adverse reactions to nonstatin drugs (OR 0.908; P < .0001) were associated with lower odds.

CONCLUSIONS: Nature and timing of the adverse reaction, patient's medical history and the medication prescribed affected the likelihood of a successful reattempt of statin therapy after an adverse reaction. These findings suggest that a patient-centered approach to restarting statins should be considered for patients at high cardiovascular risk to improve the chances of success.