Drammen, Norway—Side effects from statin therapy aren’t just bothersome distractions, according to a new study. They also are the strongest predictor of failure to meet LDL cholesterol targets.

Research published in in the European Journal of Preventive Cardiology notes that other predictors are statin nonadherence and use of weaker statins.

“The beneficial effect of reducing LDL cholesterol on slowing the progression of coronary heart disease is overwhelmingly documented today in epidemiologic and randomized controlled studies,” explained lead author John Munkhaugen, MD, a cardiology trainee and postdoctoral researcher at Drammen Hospital in Norway.

The study is an analysis of the NORwegian COR (NOR-COR) prevention project, which is investigating why patients fail to control risk factors including lipids and blood pressure after they have a cardiovascular event, and is focused on why LDL cholesterol targets aren’t achieve in these patients.

Included were 1,095 patients hospitalized with a first or recurrent coronary event or treatment—heart attack, coronary artery bypass graft, or coronary stent—who were identified from medical records at two Norwegian hospitals. Sociodemographic, medical and psychosocial information was collected from medical records; the analysis included an interdisciplinary self-report questionnaire, clinical examinations, and blood samples while patients were in the hospital and at follow-up after 2 to 36 months.

Results indicate that 57% of patients were not meeting the European guideline LDL target of 1.8 mmol/L at follow-up. The primary reasons were found to be specific statin side effects, mainly muscle complaints, as well as low statin adherence, and moderate- or low-intensity statin therapy.

In fact, study authors report that patients with side effects were more than three times more likely to miss the cholesterol target than those without side effects, and that those who did not take their statins were three times more likely to miss the target than patients who did take them. At the same time, patients prescribed moderate- or low-intensity statins were 62% more likely to miss the target than those prescribed high-intensity statins.

“We found the same three reasons for not meeting the target when LDL was analyzed as a dichotomous or continuous variable, which confirms the strength of the associations,” Munkhaugen explained.

Low socioeconomic status and psychosocial factors did not predict failure to control LDL cholesterol, according to the study.

“The relationship with adherence and side effects needs to be clarified before advice can be given about the potency of statins that should be prescribed,” Munkhaugen added. “Our findings point to the need for more research on ways to ensure adherence and prescription of sufficiently potent statins, while at the same time addressing side effects.”

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