Prevalence, Associated Risk Factors, and Adverse Cardiovascular Outcomes of Statins Discontinuation: A Systematic Review.

IF 2.4 4区医学 Q3 PHARMACOLOGY & PHARMACY Pharmacoepidemiology and Drug Safety Pub Date : 2024-08-01 DOI:10.1002/pds.5879

Shahd A Ageeb, Alaa Abdelmoghith, Hager ElGeed, Ahmed Awaisu, Abdulmoniem ElMansor, Yaw B Owusu

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Abstract

Purpose: Statins are widely prescribed for cardiovascular diseases (CVD) prevention; however, a significant proportion of users discontinue the medication for various reasons. This review aimed to determine the prevalence of statin therapy discontinuation, its associated factors, and adverse cardiovascular outcomes within the first year of discontinuation.

Methods: The PubMed, EMBASE, ScienceDirect, SCOPUS, and Google Scholar databases were systematically searched from their inception to December 2022. Manual searches were also conducted on the bibliographies of relevant articles. Studies were included for qualitative data synthesis and assessed for methodological quality.

Results: Fifty-two studies, predominantly cohort studies (n = 38), involving 4 277 061 participants were included. The prevalence of statin discontinuation within the first year of statin initiation ranged from 0.8% to 70.5%, which was higher for primary prevention indications. Factors frequently associated with an increased likelihood of statin discontinuation included male sex, nonWhite ethnicity, smoking status, and being uninsured. Conversely, discontinuation was less likely in patients with CVD who received secondary prevention statin therapy and in patients with polypharmacy. Furthermore, age showed diverse and inconsistent relationships with statin discontinuation among various age categories. Five studies that reported the cardiovascular risk of statin discontinuation within the first year of initiation showed significantly increased risk of discontinuation, including all-cause mortality (hazard ratio: 1.36-3.65).

Conclusion: Our findings indicate a high prevalence of statin discontinuation and an increased likelihood of adverse cardiovascular outcomes within the first year of discontinuation, despite wide variability across published studies. This review highlights the importance of addressing the modifiable risk factors associated with statin discontinuation, such as smoking and lack of insurance coverage.

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停用他汀类药物的患病率、相关风险因素和不良心血管后果：系统回顾

目的：他汀类药物被广泛用于心血管疾病（CVD）的预防；然而，相当一部分使用者因各种原因而停药。本综述旨在确定他汀类药物治疗停药的发生率、相关因素以及停药第一年内的不良心血管后果：方法：系统检索了 PubMed、EMBASE、ScienceDirect、SCOPUS 和 Google Scholar 数据库中从开始到 2022 年 12 月的内容。还对相关文章的书目进行了人工检索。纳入的研究进行了定性数据综合，并对方法学质量进行了评估：共纳入 52 项研究，主要是队列研究（n = 38），涉及 4 277 061 名参与者。他汀类药物使用后第一年内停药的比例从 0.8% 到 70.5%不等，其中一级预防适应症的停药比例更高。与他汀类药物停用可能性增加经常相关的因素包括男性、非白人种族、吸烟状况和无保险。相反，接受他汀类药物二级预防治疗的心血管疾病患者和使用多种药物的患者停用他汀类药物的可能性较低。此外，年龄与他汀类药物停用的关系在不同年龄段中表现出多样性和不一致性。五项研究报告了他汀类药物使用后第一年内停药的心血管风险，结果显示停药风险显著增加，包括全因死亡率（危险比：1.36-3.65）：我们的研究结果表明，他汀类药物停药的发生率很高，停药第一年内出现不良心血管后果的可能性增加，尽管已发表的研究之间存在很大差异。本综述强调了解决与他汀类药物停用相关的可改变风险因素（如吸烟和缺乏保险）的重要性。

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来源期刊

Pharmacoepidemiology and Drug Safety 医学-药学

CiteScore

4.80

自引率

7.70%

发文量

173

审稿时长

3 months

期刊介绍： The aim of Pharmacoepidemiology and Drug Safety is to provide an international forum for the communication and evaluation of data, methods and opinion in the discipline of pharmacoepidemiology. The Journal publishes peer-reviewed reports of original research, invited reviews and a variety of guest editorials and commentaries embracing scientific, medical, statistical, legal and economic aspects of pharmacoepidemiology and post-marketing surveillance of drug safety. Appropriate material in these categories may also be considered for publication as a Brief Report. Particular areas of interest include: design, analysis, results, and interpretation of studies looking at the benefit or safety of specific pharmaceuticals, biologics, or medical devices, including studies in pharmacovigilance, postmarketing surveillance, pharmacoeconomics, patient safety, molecular pharmacoepidemiology, or any other study within the broad field of pharmacoepidemiology; comparative effectiveness research relating to pharmaceuticals, biologics, and medical devices. Comparative effectiveness research is the generation and synthesis of evidence that compares the benefits and harms of alternative methods to prevent, diagnose, treat, and monitor a clinical condition, as these methods are truly used in the real world; methodologic contributions of relevance to pharmacoepidemiology, whether original contributions, reviews of existing methods, or tutorials for how to apply the methods of pharmacoepidemiology; assessments of harm versus benefit in drug therapy; patterns of drug utilization; relationships between pharmacoepidemiology and the formulation and interpretation of regulatory guidelines; evaluations of risk management plans and programmes relating to pharmaceuticals, biologics and medical devices.