Impact of obesity on tolerance and persistence of statins in patients within 3 months following an acute myocardial infarction: A real-world study

Background: Recommended treatment after acute coronary syndrome (ACS) involves high-intensity statin therapy to achieve the low-density lipoprotein (LDL-C) target of < 1.4 mmol/L (European guidelines), but many patients discontinue statins because of real or perceived side-effects. Whether body mass index (BMI) influences statin intolerance remains unclear. Aim: To assess statin tolerance 3 months after initiation, and to identify factors determining tolerance and persistence. Methods: STATIC was a single-centre cohort study (November 2021 to April 2023) of patients admitted to cardiac intensive care units for ACS. The study had three stages: T0 (admission); W6 (6 weeks after ACS: statin efficiency); and M3 (3 months after ACS: statin tolerance and persistence). SAMS score was used to evaluate imputability in patients reporting muscular side-effects. Multivariable analysis identified factors influencing tolerance; statin persistence was assessed using pharmacy dispensing data. Results: Overall, 289 patients were included (77.9% men; mean age 64.2 years; 22.7% with BMI ≥ 30 kg/m²). At T0, 38.1% had hypertension, 28.5% dyslipidaemia and 15.9% diabetes. At discharge, 269 patients received statins: 97.0% had a high-intensity statin; 43.5% had a statin/ezetimibe combination. At W6, mean LDL-C was 1.58 mmol/L, with 45.5% at the LDL-C target. At M3, 6.0% reported side-effects (3.6% muscular, 1.2% liver, 1.2% gastrointestinal). Mean SAMS score was 5.67. No significant differences in muscular or hepatic side-effects were found between patients with BMI ≥ 30 versus < 30 kg/m 2 . Persistence was 98.4% at M3 follow-up. The proportion of patients on a high-intensity statin or a statin/ezetimibe did not change from discharge to M3 (P = 0.45 and P = 1.00, respectively). Conclusions: Statins are effective, but not always enough to reach LDL-C target. Tolerance and persistence were good, with muscular side-effects as expected, but without any guarantee of statin imputability. BMI did not influence statin tolerance in this study.