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REFLECTIONS
Dyslipidaemia
Dyslipidaemia Global Newsletter #6 2023
Statin discontinuation was strongly associated
with subsequent mortality, including all-cause Dyslipidaemia
death (HR 3.54, 95% CI 3.18–3.94, p<0.001),
cardiovascular death (HR 2.39, 95% CI 2.02–2.83,
p<0.001), and myocardial infarction (HR 1.91,
95% CI 1.48–2.47, p<0.001).
The main reasons for statin discontinuation
included non-compliance, side effects, and
worsening comorbidities.
Compared with patients with statin discontinuation
because of other reasons, patients with statin
discontinuation because of non-adherence more
often were of younger age, male gender, had acute
coronary syndrome, and were currently smoking.
Patients with statin discontinuation because of
worsening comorbidities more often had advanced
age and comorbidities such as malignancy.
All-cause death Cardiovascular death Myocardial infarction*
Adjusted HR P Adjusted HR P Adjusted HR P
(95% CI) value (95% CI) value (95% CI) value
Statin discontinuation for any reasons 3.54 (3.18-3.94) <0.001 2.39 (2.02-2.83) <0.001 1.91 (1.48-2.47) <0.001
Reasons for statin discontinuation
Non-compliance 2.35 (1.69-3.27) <0.001 1.88 (1.10-3.21) 0.02 5.10 (3.42-7.60) <0.001
Side effects 2.48 (1.84-3.34) <0.001 2.50 (1.63-3.85) <0.001 2.09 (1.11-3.92) 0.02
Worsening comorbidities 22.08 (18.55-26.29) <0.001 10.71 (7.74-14.82) <0.001 1.10 (0.27-4.45) 0.89
Surgery 4.93 (3.03-8.01) <0.001 2.64 (1.08-6.42) 0.03 1.18 (0.16-8.42) 0.87
Prescription error 1.57 (0.22-11.21) 0.65 NA NA NA NA
Direction by physicians for other reasons 3.93 (3.14-4.91) <0.001 2.25 (1.51-3.36) <0.001 2.02 (1.10-3.71) 0.02
Unknown reasons 2.34 (2.01-2.73) <0.001 1.82 (1.45-2.29) <0.001 1.13 (0.75-1.72) 0.55
HRs with 95% CIs of the variables for all-cause death, cardiovascular death, and myocardial infarction were estimated by the multivariable Cox proportional
hazard models. Statin discontinuation for any reasons and the individual reasons for statin discontinuation were included as the time-updated covariates in the Cox
proportional hazard models.
* In the analysis of myocardial infarction, patients who had myocardial infarction during the index hospitalization for coronary revascularization (N=290) were excluded.
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