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Le notizie negative sulle statine influiscono sulla continuità terapeutica

Molti e diversi sono i motivi che causano l'interruzione della terapia con statine. Nielsen e Nordestgaard, con i dati del registro nazionale danese hanno ricostruito la storia della terapia con statine di quasi 675.000 pazienti dal 1995 al 2011. La sospensione della terapia è risultata correlata principalmente alle notizie negative riguardanti le statine apparse su giornali e riviste o comunicate da radio e televisione. Al secondo posto dopo i mezzi di informazione si colloca il tempo trascorso dall'inizio della terapia, poi l'aumento della dose di statina, il sesso maschile e la residenza nelle città. I risultati di questo studio si differenziano da quanto rilevato in studi precedenti che attribuivano l'interruzione della terapia soprattutto alla comparsa di disturbi attribuiti a torto o a ragione alla terapia. Dallo studio danese è risultato anche che la sospensione precoce delle statine si è associata ad un aumento del rischio di infarto del miocardio e di morte per cause cardiovascolari.

Negative statin-related news stories decrease statin persistence and increase myocardial infarction and cardiovascular mortality: a nationwide prospective cohort study

Nielsen SF, Nordestgaard BG

Eur Heart J 2016;37:908-916

AIM: We tested the hypothesis that statin-related news stories, cardiovascular disease, diabetes, statin dose, calendar year, and socio-demographic status are associated with early statin discontinuation. We also examined frequency and consequences of early statin discontinuation.
METHODS AND RESULTS: From the entire Danish population, we studied 674 900 individuals aged 40 or older who were initiated on statin therapy in 1995-2010, and followed them until 31 December 2011. Individuals on statins increased from <1% in 1995 to 11% in 2010, while early statin discontinuation increased from 6% in 1995 to 18% in 2010. The odds ratios for early statin discontinuation vs. continued use were 1.09 (95% confidence interval, 1.06-1.12) for negative statin-related news stories, 1.04 (1.02-1.07) per increasing calendar year, 1.04 (1.02-1.06) per increasing defined daily dose of statin, 1.05 (1.03-1.06) for male sex, 1.13 (1.11-1.15) for living in cities, 1.67 (1.63-1.71) for other ethnicity than Danish, 0.92 (0.90-0.94) for positive statin-related news stories, 0.73 (0.72-0.74) for baseline cardiovascular disease, and 0.91 (0.90-0.93) for baseline diabetes. During follow-up, the hazard ratios for individuals with vs. without early statin discontinuation were 1.26 (1.21-1.30) for myocardial infarction and 1.18 (1.14-1.23) for death from cardiovascular disease.
CONCLUSION: Early statin discontinuation increased with negative statin-related news stories, calendar year, statin dose, male sex, living in cities, and with other ethnicity than Danish, while the opposite was true for positive statin-related news stories and for baseline cardiovascular disease and diabetes. Early statin discontinuation was also associated with increased risk of myocardial infarction and death from cardiovascular disease.

Eur Heart J 2016;37:908-916