Avoid changes to statin therapy if no good reason
Statin therapy should not be stopped or changed without good reason, a review published in Bandolier concludes.
The reviewers found two pieces of evidence which imply that stopping
or changing statin therapy
could increase vascular risk by about three fold.
The first, an audit of 126 patients in New Zealand whose simvastatin
therapy (mean dose 22mg) was changed to fluvastatin (Lescol, mean dose
37mg), revealed that changing statins increased total cholesterol, low
density lipoprotein-cholesterol or triglyceride levels in 94 per cent
of patients. Thrombotic events increased from nine during the final six
months of simvastatin therapy to 27 during the first six months of fluvastatin
therapy.
The second piece of evidence came from a randomised trial that looked
at cardiovascular events among several subgroups of patients admitted
to hospital with chest pain. As expected, patients who were treated with
statins before and after admission had lower event rates than other patients.
However, those who had their statin therapy withdrawn had higher event
rates than those never treated with a statin. “Neither study is
definitive and merely serve to generate hypotheses,” say the reviewers.
However, they conclude: “Perhaps the take home message is not to
mess about with statin therapy without a very good reason, and to make
sure that lipid control is not impaired.” |
