Safety of long-term simvastatin discontinuation

摘要

The results of post-trial analysis of the Heart Protection Study (HPS; Dec 10, p 2013)1 are extremely interesting because they show the efficacy and safety of long-term treatment with simvastatin. However, in our opinion, the statement that "even after in-study treatment stopped in HPS, the benefits persisted for several years" could be misleading. This statement might suggest that statin withdrawal has no deleterious effects in terms of vascular events, confirming what was previously noted in patients with stable coronary disease (TNT trial).2 However, this notion is contradicted by various observations in real-world clinical settings.34 Furthermore, statin withdrawal could induce a proatherothrombotic state even in patients treated with other antiatherothrombotic agents and cause a related increase in LDL cholesterol.