Treatment strategies and LDL cholesterol target attainment in patients with statin intolerance: Insights from the multicentre statin intolerance registry

Statin intolerance (SI) is an important cause of insufficient low-density lipoprotein cholesterol (LDL-C) target attainment. Contemporary treatment strategies and symptoms in patients with SI are incompletely understood. We report baseline lipid-lowering therapies (LLTs) and LDL-C target attainment in the Statin Intolerance Registry, an observational, prospective, multicenter study that recruited 1,111 patients with SI between 2021–2023 in Germany. The mean age was 66.1 (SD 9.9) years, 57.7% were female. At study inclusion, 83.1% received at least one LLT, and 47.0% received combination LLT. A higher number of LLTs was associated with lower LDL-C, lower systolic blood pressure, more atherosclerotic disease, more elevations of creatine kinase and liver enzymes but not with impaired quality of life as measured by EuroQol (EQ-5D-5L). PCSK9 inhibitors were most frequently prescribed (48.0%), followed by ezetimibe (39.2%), statins (26.9%), most commonly rosuvastatin, and bempedoic acid (25.4%). Patients who had been prescribed multiple statins before were more likely to take a statin at baseline. Patients on a statin, even at low intensity, had lower LDL-C levels compared to patients without statin therapy (mean [SD] 2.4 [1.2] vs. 2.9 [1.6] mmol/L, p<0.001). Significantly more men than women achieved the LDL-C target (21.7% vs. 11.4%, p<0.001, total cohort: 15.8%). LDL-C target attainment is low in patients with SI, especially among women, despite high cardiovascular risk. The use of a greater number of LLTs, including statins, is not associated with reduced quality of life but is associated with lower LDL-C levels.