Background Statin therapy is a proven effective treatment of hyperlipidemia.However,a significant number of patients cannot tolerate statins.This study was conducted to review treatment strategies for patients intolerant to statin therapy with a focus on intermittent statin dosing.Methods and Results We performed a retrospective analysis of medical records of 1,605 patients referred to the Cleveland Clinic Preventive Cardiology Section for statin intolerance between January 1995 and March 2010 with at least a6-month follow-up.The changes in lipid profile,achievement of low-density lipoprotein cholesterol(LDL-C)goals,and statin tolerance rate were analyzed.Most(72.5%)of patients with prior statin intolerance were able to tolerate a statin for the median follow-up time of 31 months.Patients on intermittent statin dosing(n=149)had significantly lower LDL-C reduction compared with daily dosing group(n=1,014;21.3%±4.0%vs27.7%±1.4%,P<0.04).However,compared with the statin discontinued group(n=442),they had a significantly higher LDL-C reduction(21.3%±4.0%vs 8.3±2.2%,P<0.001),and a significantly higher portion achieved their Adult Treatment PanelⅢgoal of LDL-C(61%vs 44%,P<0.05).There was a trend toward a decrease in all-cause mortality at 8 years for patients on daily and intermittent statin dosing compared with those who discontinued statin(P=0.08).Conclusions Most patients with previous statin intolerance can tolerate subsequent trial of statin.A strategy of intermittent statin dosing can be an effective therapeutic option in some patients and may result in reduction in LDL-C and achievement of LDL-C goals.
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