Effectiveness and Tolerability of Alternative Statin Dosing in Daily Statin Intolerant Patients in the Era of PCSK9 Inhibitors

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Author Info

Anthony P. Morise Jennifer A. Tennant

Corresponding Author

Anthony P. Morise
West Virginia University Heart and Vascular Institute, Morgantown, West Virginia, USA

A B S T R A C T

Background: Intolerance to the daily use of statins can be dealt with by the use of Proprotein Catylase Subtilisin Kexin Type 9 (PCSK9) inhibitors. Alternative statin dosing has previously been utilized in patients with statin intolerance. Methods: Since the introduction of PCSK9 inhibitors for clinical use in 2015, we evaluated the effectiveness of alternative statin dosing in patients with daily statin intolerance defined as the inability to tolerate the daily use of any dose of statin. Alternative statin dosing was defined as weekly, twice weekly, or every other day atorvastatin or rosuvastatin. From our lipid clinic population of 505 patients with primary hypercholesterolemia (71% with atherosclerotic cardiovascular disease), 338 (67%) had daily statin intolerance. Alternative statin dosing was agreed to by 122 patients of these 338. At the time of this analysis, 87 patients (59% with atherosclerotic cardiovascular disease) could be assessed concerning the effectiveness of alternative statin dosing to achieve their LDL-cholesterol goal. Results: Of the 87 patients undergoing alternative statin dosing with or without ezetimibe, 30 (34%) achieved their goal. An additional 22 patients had a >30% reduction in LDL-cholesterol with oral therapy alone. Twenty-nine of the 87 patients later received PCSK9 inhibition with 27 achieving either their goal or a >30% reduction in LDL cholesterol. The baseline LDL-cholesterol of those achieving their goal LDLcholesterol with alternative statin dosing (154 + 40 mg/dL) could not be distinguished (p=0.79) from those who later required PCSK9 inhibition to achieve their goal (157 + 41 mg/dL). Intolerance to alternative statin dosing was seen in 24 of the 87 (28%) patients. Conclusion: In conclusion, prior to initiating PCSK9 inhibition in patients with daily statin intolerance, a trial of alternative statin dosing should be attempted. The success of alternative statin dosing cannot be predicted by the baseline level of LDL-cholesterol.

Article Info

Article Type

Research Article

Publication history

Received: Tue 21, Apr 2020
Accepted: Fri 22, May 2020
Published: Thu 28, May 2020

Copyright

© 2023 Anthony P. Morise. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Hosting by Science Repository.
DOI: 10.31487/j.JICOA.2020.03.05