Abstract：
OBJECTIVE: Statins are widely prescribed for cardiovascular diseases (CVD) prevention; however, a significant proportion of users discontinue the medication for various reasons. This review aimed to determine the prevalence of statin therapy discontinuation, its associated factors, and adverse cardiovascular outcomes within the first year of discontinuation.
METHODS: The PubMed, EMBASE, ScienceDirect, SCOPUS, and Google Scholar databases were systematically searched from their inception to December 2022. Manual searches were also conducted on the bibliographies of relevant articles. Studies were included for qualitative data synthesis and assessed for methodological quality.
RESULTS: Fifty-two studies, predominantly cohort studies (n = 38), involving 4 277 061 participants were included. The prevalence of statin discontinuation within the first year of statin initiation ranged from 0.8% to 70.5%, which was higher for primary prevention indications. Factors frequently associated with an increased likelihood of statin discontinuation included male sex, nonWhite ethnicity, smoking status, and being uninsured. Conversely, discontinuation was less likely in patients with CVD who received secondary prevention statin therapy and in patients with polypharmacy. Furthermore, age showed diverse and inconsistent relationships with statin discontinuation among various age categories. Five studies that reported the cardiovascular risk of statin discontinuation within the first year of initiation showed significantly increased risk of discontinuation, including all-cause mortality (hazard ratio: 1.36-3.65).
CONCLUSIONS: Our findings indicate a high prevalence of statin discontinuation and an increased likelihood of adverse cardiovascular outcomes within the first year of discontinuation, despite wide variability across published studies. This review highlights the importance of addressing the modifiable risk factors associated with statin discontinuation, such as smoking and lack of insurance coverage.
METHODS: The PubMed, EMBASE, ScienceDirect, SCOPUS, and Google Scholar databases were systematically searched from their inception to December 2022. Manual searches were also conducted on the bibliographies of relevant articles. Studies were included for qualitative data synthesis and assessed for methodological quality.
RESULTS: Fifty-two studies, predominantly cohort studies (n = 38), involving 4 277 061 participants were included. The prevalence of statin discontinuation within the first year of statin initiation ranged from 0.8% to 70.5%, which was higher for primary prevention indications. Factors frequently associated with an increased likelihood of statin discontinuation included male sex, nonWhite ethnicity, smoking status, and being uninsured. Conversely, discontinuation was less likely in patients with CVD who received secondary prevention statin therapy and in patients with polypharmacy. Furthermore, age showed diverse and inconsistent relationships with statin discontinuation among various age categories. Five studies that reported the cardiovascular risk of statin discontinuation within the first year of initiation showed significantly increased risk of discontinuation, including all-cause mortality (hazard ratio: 1.36-3.65).
CONCLUSIONS: Our findings indicate a high prevalence of statin discontinuation and an increased likelihood of adverse cardiovascular outcomes within the first year of discontinuation, despite wide variability across published studies. This review highlights the importance of addressing the modifiable risk factors associated with statin discontinuation, such as smoking and lack of insurance coverage.
摘要：
目的：他汀类药物广泛用于心血管疾病（CVD）预防；然而，相当比例的使用者因各种原因停止用药。这篇综述旨在确定他汀类药物治疗中断的患病率，其相关因素，以及停药后第一年内的不良心血管结局.
方法：PubMed，EMBASE,ScienceDirect,Scopus,和GoogleScholar数据库从成立到2022年12月进行了系统搜索。还对相关文章的参考书目进行了手动搜索。包括定性数据综合研究，并评估方法学质量。
结果：52项研究，主要是队列研究（n=38），纳入4277061名参与者.在开始他汀类药物的第一年内，他汀类药物停药的患病率为0.8％至70.5％。一级预防指征较高。经常与他汀类药物停药可能性增加相关的因素包括男性，非白人种族,吸烟状况,没有保险。相反，接受二级预防他汀类药物治疗的CVD患者和接受多重用药的患者停药的可能性较小.此外，在不同年龄类别中,年龄与他汀类药物停药的关系不同且不一致.5项研究报告了在开始治疗的第一年内他汀类药物停药的心血管风险，显示停药风险显著增加。包括全因死亡率（危险比：1.36-3.65）。
结论：我们的研究结果表明，他汀类药物停药的患病率很高，停药后第一年内发生不良心血管结局的可能性增加。尽管在已发表的研究中差异很大。这篇综述强调了解决与他汀类药物停药相关的可改变危险因素的重要性，比如吸烟和缺乏保险。
方法：PubMed，EMBASE,ScienceDirect,Scopus,和GoogleScholar数据库从成立到2022年12月进行了系统搜索。还对相关文章的参考书目进行了手动搜索。包括定性数据综合研究，并评估方法学质量。
结果：52项研究，主要是队列研究（n=38），纳入4277061名参与者.在开始他汀类药物的第一年内，他汀类药物停药的患病率为0.8％至70.5％。一级预防指征较高。经常与他汀类药物停药可能性增加相关的因素包括男性，非白人种族,吸烟状况,没有保险。相反，接受二级预防他汀类药物治疗的CVD患者和接受多重用药的患者停药的可能性较小.此外，在不同年龄类别中,年龄与他汀类药物停药的关系不同且不一致.5项研究报告了在开始治疗的第一年内他汀类药物停药的心血管风险，显示停药风险显著增加。包括全因死亡率（危险比：1.36-3.65）。
结论：我们的研究结果表明，他汀类药物停药的患病率很高，停药后第一年内发生不良心血管结局的可能性增加。尽管在已发表的研究中差异很大。这篇综述强调了解决与他汀类药物停药相关的可改变危险因素的重要性，比如吸烟和缺乏保险。
