Background
Statin intolerance (SI) is a common occurrence and an important cause of missed low-density lipoprotein (LDL) cholesterol targets. It is currently unknown, whether SI leads to changes in lipid-lowering therapy and achievement of LDL cholesterol targets, in particular in a specialised outpatient clinic for lipid management.
Aim:
To evaluate and compare the lipid-lowering therapy in patients with and without SI.
Methods
The present analysis is based on consecutive patients presenting to our tertiary outpatient lipid clinic between 2022 and 2025. Patients with missing or incomplete information on lipid-lowering-therapy were excluded. Patients’ cardiovascular risk was assessed according to the 2019 ESC/EAS-guidelines for the management of dyslipidaemias. We performed descriptive analyses on the medical lipid management, comparing the frequency of different medications in patients with and without SI.
Results:
Overall, data from 5783 patient presentations (mean age 60.7 ± 13.4 years) were included for the present analysis. 4107 (79.2%) were at very high or extreme risk for cardiovascular events with an LDL cholesterol target of ≤55 or ≤40 mg/dl. 114 (3.14%) received a low intensity statin therapy, 1277 (35.2%) a moderate intensity statin therapy, while 2235 (61.64%) were treated with a high intensity statin therapy. In addition, 2693 (46.6%) patients were treated with ezetimibe, 1163 (20.1%) with bempedoic acid and 815 (14.1%) with a PCSK9-inhibitor or inclisiran.
SI was documented in 1435 (24.8%) patients. Of those 266 (18.5%) were intolerant to 2 statins, 679 (47.3%) to 3 or more statins. 1137 (79.2%) of patients with SI had a very high or extreme risk for cardiovascular events. Any statin therapy was present in 594 patients (41.4%) despite SI, but patients with SI were more frequently treated with a low-intensity statin therapy (13.3% vs. 1.2%) than patients without SI. In contrast, patients with SI were more likely to receive bempedoic acid (33.3% vs. 15.8%) and PCSK9-inhibitors or inclisiran (32.8% vs. 7.9%) than patients without SI.
Conclusion
In the present analysis of consecutive patients presenting to a tertiary outpatient lipid clinic, SI occurred in 25% of the presentations. 40% of patients with SI tolerated statin therapy while low-intensity statin therapy was more frequently present than in patients without SI. SI led to broader application of intensified lipid-lowering strategies including the utilization of bempedoic acid and PCSK9-inhibitors or inclisiran.
