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Alternate Day Statin Therapy

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Alternate Day Statin Therapy

Statins have been shown to reduce LDL-C, total cholesterol (TC), and triglycerides (TG) levels, potentially decreasing the risk of cardiovascular disease and death. Unfortunately, they can be difficult to administer and associated with various adverse reactions like gastrointestinal disturbances, myalgia, muscle weakness and memory loss. Alternate day statin therapy has emerged as a novel alternative treatment strategy for those who find daily statin regimens too much of an inconvenience – with studies showing fewer adverse reactions than daily dosing.

Myalgia is one of the most frequent side effects of statins and it’s typically described as muscular-skeletal pain in the back, shoulders or arms. Myalgia occurs both with daily and alternate day dosage regimens of statins; physical exercise being the primary trigger; however other causes could include environmental stressors, dietary or climatic influences, alcohol consumption or drugs taken, as well as emotional factors.

Hydrophilic statins that are active in hepatocytes, rather than lipophilic ones that aren’t, may help reduce myalgia symptoms. Alternating day doses of atorvastatin, simvastatin and rosuvastatin can be used as a first-line strategy for managing statin-associated myalgia. Intermittent dosing also works well during pregnancy and breastfeeding to avoid the occurrence of myalgia.

Some small studies have suggested that alternate day statin therapy for LDL-C reduction is just as successful as daily dosing. Unfortunately, these tests were short term and had limited adherence and outcome data. Therefore, more long-term trials are necessary to determine whether alternate day statin therapy helps reduce cardiovascular events.

A systematic review and meta-analysis was conducted on clinical trials comparing alternate day statin therapy to daily dosing. Data were pulled from PubMed, SCOPUS, Web of Science and EMBASE databases; 12 randomized controlled trials (RCTs) and one quasi-RCT involved 1023 patients meeting eligibility criteria.

These studies were analyzed to compare LDL-C reduction between alternate day and daily statin groups using Open Meta-Analyt, when available. The mean difference in LDL-C reduction for each study was determined. The pooled result from all 12 RCTs was then compared with that from one quasi-RCT and calculated as the mean LDL-C reduction when taking alternate day versus daily dosing.

The combined results from all cited studies demonstrated that alternate day statin therapy was just as effective as daily statin therapy in reducing cardiovascular events, particularly among atorvastatin treatment naive patients. Furthermore, their overall lipid profiles were similar; the only noticeable distinction was LDL-C to HDL-C ratio which likely reflects that HDL-C levels remain unchanged during alternate day dosage.

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