Addressing Key Questions with Statin Therapy

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Medical Education Library

Addressing Key Questions with Statin Therapy

June 2012 · Vol. 61, No. 06 Suppl: S34-S39

By

Peter P. Toth, MD, PhD

References

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11. Yanagi K, Monden T, Ikeda S, Matsumura M, Kasai K. A crossover study of rosuvastatin and pitavastatin in patients with type 2 diabetes. Adv Ther. 2011;28(2):160-171.

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24. Boekholdt SM, Arsenault BJ, Mora S, et al. Association of LDL cholesterol, non-HDL cholesterol, and apolipoprotein B levels with risk of cardiovascular events among patients treated with statins: a meta-analysis. JAMA. 2012;307(12):1302-1309.

25. US Food and Drug Administration. FDA drug safety communication: Important safety label changes to cholesterol-lowering statin drugs. http://www.fda.gov/Drugs/DrugSafety/ucm293101.htm. Published 2012. Accessed May 18, 2012.

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27. Koh KK, Quon MJ, Han SH, Lee Y, Kim SJ, Shin EK. Atorvastatin causes insulin resistance and increases ambient glycemia in hypercholesterolemic patients. J Am Coll Cardiol. 2010;55(12):1209-1216.

28. Preiss D, Seshasai SR, Welsh P, et al. Risk of incident diabetes with intensive-dose compared with moderate-dose statin therapy: a meta-analysis. JAMA. 2011;305(24):2556-2564.

29. Yokote K, Saito Y. CHIBA study investigators. Influence of statins on glucose tolerance in patients with type 2 diabetes mellitus: subanalysis of the collaborative study on hypercholesterolemia drug intervention and their benefits for atherosclerosis prevention (CHIBA study). J Atheroscler Thromb. 2009;16(3):297-298.

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31. Bottorff MB. Statin safety and drug interactions: clinical implications. Am J Cardiol. 2006;97(8A):27C-31C.

32. Andrus MR. Oral anticoagulant drug interactions with statins: case report of fluvastatin and review of the literature. Pharmacotherapy. 2004;24(2):285-290.

33. US Food and Drug Administration. FDA drug safety communication: Interactions beteween certain HIV or hepatitis C drugs and cholesterol-lowering statin drugs can increase the risk of muscle injury. http://www.fda.gov/Drugs/DrugSafety/ucm293877.htm. Published 2012. Accessed May 18, 2012.

34. Armitage J, Bowman L, Wallendszus K, et al. for Study of the Effectiveness of Additional Reductions in Cholesterol and Homocysteine (SEARCH) Collaborative Group. Intensive lowering of LDL cholesterol with 80 mg versus 20 mg simvastatin daily in 12,064 survivors of myocardial infarction: a double-blind randomised trial. Lancet. 2010;376(9753):1658-1669.

35. de Lemos JA, Blazing MA, Wiviott SD, et al. for A to Z Investigators. Early intensive vs a delayed conservative simvastatin strategy in patients with acute coronary syndromes: phase Z of the A to Z trial. JAMA. 2004;292(11):1307-1316.

36. Backes JM, Howard PA, Ruisinger JF, Moriarty PM. Does simvastatin cause more myotoxicity compared with other statins? Ann Pharmacother. 2009;43(12):2012-2020.

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38. Toth PP, Dayspring TD. Drug safety evaluation of rosuvastatin. Expert Opin Drug Saf. 2011;10(6):969-986.

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41. Albert MA, Glynn RJ, Fonseca FA, et al. Race, ethnicity, and the efficacy of rosuvastatin in primary prevention: the Justification for the Use of Statins in Prevention: an Intervention Trial Evaluating Rosuvastatin (JUPITER) trial. Am Heart J. 2011;162(1):106-114.

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Table of Contents

Introduction

Managing the Multiple Symptoms of Benign Prostatic Hyperplasia — CME

The Treatment of Gout

Managing Type 2 Diabetes in Men

Meeting New Challenges with Antiplatelet Therapy in Primary Care

Coronary Heart Disease in Men

Addressing Key Questions with Statin Therapy — CME

DISCLOSURES

Dr. Toth has disclosed that he is on the speakers’ bureaus and is a consultant for Abbott, AstraZeneca, Kowa, Lilly, and Merck. He is on the speakers’ bureaus for Boehringer-Ingelheim and GlaxoSmithKline and is a consultant for Genentech and Genzyme.

Statins have become an important therapeutic option for managing cardiovascular (CV) risk, yet many questions remain regarding their use. This article addresses some of these questions in the primary care management of patients and highlights the impact of long-term statin therapy on CV end points. Because pitavastatin has recently become available in the United States, more detailed information about this agent is also presented.

CONTINUING MEDICAL EDUCATION

LEARNING OBJECTIVES

After reviewing this activity on statin therapy, the reader will be able to:

Describe the long-term benefits of statin therapy.
Compare the efficacy and safety of pitavastatin with other statins.
Select and modify statin therapy based upon individual patient factors.

TARGET AUDIENCE

Family physicians and clinicians who wish to gain increased knowledge and greater competency regarding statin therapy in the primary care management of patients with dyslipidemia.

ACKNOWLEDGEMENT

Dr. Toth was paid an honorarium by and received editorial assistance from the Primary Care Education Consortium in the development of this activity.

DISCLOSURES

As a continuing medical education provider accredited by the Accreditation Council for Continuing Medical Education (ACCME), it is the policy of the Primary Care Education Consortium (PCEC) to require any individual in a position to influence educational content to disclose the existence of any financial interest or other personal relationship with the manufacturer(s) of any commercial product(s).

Dr. Toth has disclosed that he is on the speakers’ bureaus and is a consultant for Abbott, AstraZeneca, Kowa, Lilly, and Merck. He is on the speakers’ bureaus for Boehringer-Ingelheim and GlaxoSmithKline and is a consultant for Genentech and Genzyme.

The medical accuracy and continuing medical education (CME) reviewer for this activity, Dr. Ron Pollack, has no real or apparent conflicts of interest to report.

PRIMARY CARE EDUCATION CONSORTIUM STAFF

Dr. Brunton has disclosed that he is on the advisory boards and speakers’ bureaus for Boehringer Ingelheim, Eli Lilly, Kowa, Novo Nordisk, Inc, and Teva Pharmaceuticals, and is on the advisory boards for Abbott and Sunovion.

Other PCEC staff has provided financial disclosure and have no conflicts of interest to resolve related to this activity.

CONFLICTS OF INTEREST

When individuals in a position to control content have reported financial relationships with one or more commercial interests, the Primary Care Education Consortium works with them to resolve such conflicts to ensure that the content presented is free of commercial bias. The content of this activity was vetted by the following mechanisms and modified as required to meet this standard:

Content peer-review by an external topic expert
Content peer-review by an external CME reviewer
Content validation by internal Primary Care Education Consortium clinical editorial staff

OFF-LABEL DISCLOSURE

In accordance with ACCME guidelines, the faculty author has been asked to disclose discussion on unlabeled or unapproved uses of drugs or devices during the course of the activity.

SPONSORSHIP

This activity is sponsored by the Primary Care Education Consortium.

ACCREDITATION

This journal-based CME activity, Addressing Key Questions with Statin Therapy, has been reviewed and is acceptable for up to 1.0 prescribed credit by the American Academy of Family Physicians. AAFP accreditation begins June 1, 2012. Term of approval is for one year from this date with option for yearly renewal.

Physicians should claim only the credit commensurate with the extent of their participation in the activity.

MEDIUM

Text publication in the form of a journal article.

METHOD OF PHYSICIAN PARTICIPATION

To receive CME credit, please read the journal article, and upon completion go to: www.pceconsortium.org/menshealthSTATIN to complete the online evaluation to receive your certification of completion.

SUPPORT

This activity was supported by an educational grant from Kowa Pharmaceuticals America, Inc. and Lilly USA, LLC.

Recent Clinical Evidence

Findings from clinical trials continue to add to our understanding of the safety and efficacy of statin therapy; for example, extended follow-up studies from 2 landmark trials show lasting benefit and no evidence of emerging hazards. An analysis of the Heart Protection Study demonstrated that participants randomized to simvastatin 40 mg during the initial 5-year trial had maintained the vascular event reduction of 23% (95% confidence interval [CI], 19-28; P < .0001) at the 6-year follow-up.¹ Similarly, 8 years after the close of the 3-year lipid-lowering arm of the Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT), primary prevention patients originally randomized to atorvastatin had maintained a 14% reduction in all-cause mortality (95% CI, 0.76-0.98; P = .02) and a 15% lower rate of non-CV death (95% CI, 0.73-0.99; P = .03) compared with placebo.² Cancer incidence among those receiving a statin versus those receiving a placebo was similar in both trials. Collectively, these data provide reassurance for the long-term continuation of statin therapy.