One-year treatment trajectories of patients with statin intolerance: results from a multicentre registry

Aims Statin intolerance (SI) is a common phenomenon that has been associated with increased cardiovascular risk. Prospective data on the treatment course of patients with SI are scarce. Methods In the observational, prospective, multicentre statin intolerance registry, 1,111 patients with SI, defined as intolerance to at least two different statins, were recruited between 2021 and 2023 in Germany. We report results of the one-year follow-up, stratified by persisting pain (self-report of at least moderate symptoms in the EQ-5D-5L dimension of pain/discomfort at baseline and follow-up) and by patient characteristics. Results Data of 1,032 patients were available at one-year follow-up, of which 39.1% reported persisting, 34.2% no, 11.9% new, and 14.8% resolved pain. Patients with persisting pain were more often female, older, had more co-morbidities, lower quality of life, and more often discontinued lipid-lowering therapy (LLT). During follow-up, 43.2% of patients had an escalation of LLT, 17.0% de-escalation, and 39.8% no change. This resulted in LDL cholesterol (LDL-C) reductions from median (IQR) 2.3 (1.6-3.6) mmol/L at baseline to 2.0 (1.4-2.8) mmol/L after one year, while LDL-C target attainment improved from 18.0 to 24.0%. Women had more often de-escalation of LLT and a significantly smaller improvement in LDL-C target attainment than men. Conclusion While LDL-C values improved during follow-up, three in four statin-intolerant patients still did not achieve their LDL-C targets and many patients reported persisting pain, especially women. Our results provide a rationale for tailored approaches to improve care in these patients.