Discontinuation of Statins in Routine Care Settings
Authors: Thomas W. LeBlanc, Jean S. Kutner, Christine S. Ritchie, Amy P. Abernethy
Journal: Annals of Internal Medicine (2013)

Letters2 July 2013Discontinuation of Statins in Routine Care SettingsThomas W. LeBlanc, MD, MA, Jean S. Kutner, MD, MSPH, Christine S. Ritchie, MD, MSPH, and Amy P. Abernethy, MDThomas W. LeBlanc, MD, MAFrom Duke University, Durham, North Carolina; University of Colorado School of Medicine, Aurora, Colorado; University of California, San Francisco, San Francisco, California; and Duke University, Durham, North Carolina.Search for more papers by this author, Jean S. Kutner, MD, MSPHFrom Duke University, Durham, North Carolina; University of Colorado School of Medicine, Aurora, Colorado; University of California, San Francisco, San Francisco, California; and Duke University, Durham, North Carolina.Search for more papers by this author, Christine S. Ritchie, MD, MSPHFrom Duke University, Durham, North Carolina; University of Colorado School of Medicine, Aurora, Colorado; University of California, San Francisco, San Francisco, California; and Duke University, Durham, North Carolina.Search for more papers by this author, and Amy P. Abernethy, MDFrom Duke University, Durham, North Carolina; University of Colorado School of Medicine, Aurora, Colorado; University of California, San Francisco, San Francisco, California; and Duke University, Durham, North Carolina.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-159-1-201307020-00021 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:Zhang and colleagues (1) describe the frequency and nature of statin discontinuation at 2 large academic medical centers. The observed discontinuation rate was quite high, with more than 50% of patients stopping these agents at some point during the 8-year study. The article and accompanying editorial suggest that this problem should be systematically resolved (2). However, discontinuation of statins may be appropriate in certain settings.A growing literature points toward the potentially problematic nature of statin use, such as increased symptomatic adverse effects and contribution to polypharmacy, in the setting of advanced or serious comorbid illness. There ...References1. Zhang H, Plutzky J, Skentzos S, Morrison F, Mar P, Shubina M, et al. Discontinuation of statins in routine care settings: a cohort study. Ann Intern Med. 2013;158:526-34 LinkGoogle Scholar2. Grundy SM. Statin discontinuation and intolerance: the challenge of lifelong therapy [Editorial]. Ann Intern Med. 2013;158:562-3 LinkGoogle Scholar3. Garfinkel D and Mangin D. Feasibility study of a systematic approach for discontinuation of multiple medications in older adults: addressing polypharmacy. Arch Intern Med. 2010;170:1648-54. [PMID: 20937924] CrossrefMedlineGoogle Scholar4. Leblanc TW, Kutner JS, Ko D, Wheeler JL, Bull J, and Abernethy AP. Developing the evidence base for palliative care: formation of the palliative care research cooperative and its first trial. Hosp Pract (1995). 2010;38:137-43. [PMID: 20890063] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAuthors: Thomas W. LeBlanc, MD, MA; Jean S. Kutner, MD, MSPH; Christine S. Ritchie, MD, MSPH; Amy P. Abernethy, MDAffiliations: From Duke University, Durham, North Carolina; University of Colorado School of Medicine, Aurora, Colorado; University of California, San Francisco, San Francisco, California; and Duke University, Durham, North Carolina.Disclosures: Dr. LeBlanc: Support to travel to meetings for the study or other purposes (money to institution): National Institutes of Health/National Institute of Nursing Research. Dr. Kutner: Grant (money to institution): National Institutes of Health/National Institute of Nursing Research; Consultancy (money to institution): Informed Medical Decisions Foundation; Royalties: McGraw-Hill; Travel/accommodations/meeting expenses unrelated to activities listed: Society of General Internal Medicine, American Academy of Hospice and Palliative Medicine. Dr. Ritchie: Grant (money to institution): National Institutes of Health/National Institute of Nursing Research; Grants/grants pending (money to institution): Commonwealth Fund, National Institutes of Health/National Institute on Aging, Retirement Research Foundation; Royalties: UpToDate; Travel/accommodations/meeting expenses unrelated to activities listed: American Academy of Hospice and Palliative Medicine. Dr. Abernathy: Grant (money to institution): National Institutes of Health/National Institute of Nursing Research; Board membership (money to institution): American Academy of Hospice and Palliative Medicine; Board membership: Advoset, Orange Leaf Associates; Consultancy (money to institution): Novartis, Pfizer, Bristol-Myers Squibb; Other (money to institution): National Institute of Nursing Research, National Cancer Institute, Agency for Healthcare Research and Quality, Robert Wood Johnson Foundation, Biovex, DARA, Helisinn, MiCo, Pfizer, Eli Lilly, Genentech, Dendreon, Alexion, Amgen, Novartis. 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