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Intolleranza alle statine e rischio di recidiva di malattie cardiovascolari

L'intolleranza alle statine è un problema che con il passare degli anni sta diventando sempre più emergente. Non sempre è facile stabilire se l'intolleranza sia reale ma, a prescindere da ciò, è un problema che spinge spesso il paziente a sospendere il farmaco o a ridurre la dose o ad assumere altri a farmaci meno efficaci con il risultato che il target terapeutico non viene raggiunto.
In questo studio retrospettivo Serben e coll. hanno valutato il rischio di eventi coronarici e di mortalità in pazienti che hanno già avuto un infarto miocardico mettendo a confronto un gruppo di pazienti intolleranti alla statine con pazienti altamente aderenti alla terapia. La conclusione a cui giungono gli autori è che i pazienti con una intolleranza alle statine hanno un rischio di recidiva di infarto miocardico e di malattia coronarica più elevato rispetto ai pazienti che assumono la terapia in modo adeguato

Statin Intolerance and Risk of Coronary Heart Events and All-Cause Mortality Following Myocardial Infarction

Serban MC, Colantonio LD, Manthripragada AD, Monda KL, Bittner VA, Banach M, Chen L, Huang L, Dent R, Kent ST, Muntner P, Rosenson RS

J Am Coll Cardiol 2017; 69:1386-1395

BACKGROUND: Many patients report adverse reactions to, and may not tolerate, statin therapy. These patients may be at increased risk for coronary heart disease (CHD) events and mortality.
OBJECTIVES: This study evaluated the risk for recurrent myocardial infarction (MI), CHD events, and all-cause mortality in Medicare beneficiaries with statin intolerance and in those with high adherence to statin therapy.
METHODS: We studied 105,329 Medicare beneficiaries who began a moderate- or high-intensity statin dosage after hospitalization for MI between 2007 and 2013. Statin intolerance was defined as down-titrating statins and initiating ezetimibe therapy, switching from statins to ezetimibe monotherapy, having International Classification of Diseases, 9th revision, diagnostic codes for rhabdomyolysis or an antihyperlipidemic adverse event, followed by statin down-titration or discontinuation, or switching between =3 types of statins within 1 year after initiation. High statin adherence over the year following hospital discharge was defined as proportion of days covered =80%. Recurrent MI, CHD events (recurrent MI or a coronary revascularization procedure), and mortality were identified from 1 year after hospital discharge through December 2014.
RESULTS: Overall, 1,741 patients (1.65%) had statin intolerance, and 55,567 patients (52.8%) had high statin adherence. Over a median of 1.9 to 2.3 years of follow-up, there were 4,450 recurrent MIs, 6,250 CHD events, and 14,311 deaths. Compared to beneficiaries with high statin adherence, statin intolerance was associated with a 36% higher rate of recurrent MI (41.1 vs. 30.1 per 1,000 person-years, respectively), a 43% higher rate of CHD events (62.5 vs. 43.8 per 1,000 person-years, respectively), and a 15% lower rate of all-cause mortality (79.9 vs. 94.2 per 1,000 person-years, respectively). The multivariate-adjusted hazard ratios (HR) comparing beneficiaries with statin intolerance versus those with high statin adherence were 1.50 (95% confidence interval [CI]: 1.30 to 1.73) for recurrent MI, 1.51 (95% CI: 1.34 to 1.70) for CHD events, and 0.96 (95% CI: 0.87 to 1.06) for all-cause mortality.
CONCLUSIONS: Statin intolerance was associated with an increased risk for recurrent MI and CHD events but not all-cause mortality

J Am Coll Cardiol 2017; 69:1386-1395