Abstract

Background: HMG-CoA reductase inhibitors (statins) are efficacious for treatment and prevention of cardiovascular disease (CVD). Adherence is problematic due to side effects which prevent high risk patients from receiving benefit from statins.
Aim: The aim of this study was to evaluate the effectiveness of a nurse practitioner (NP) alternate statin dosing protocol for the reduction of total cholesterol (TC) and low-density lipoprotein (LDL-C).
Methods: 15 women who had the inability to tolerate daily dosing were analyzed using a novel NP protocol for initiation and maintenance of alternate dosing utilizing atorvastatin, pravastatin, or rosuvastatin. Patients were started on twice weekly statin dosing for 4 weeks then titrated up one dose per week as tolerated. While on alternate statin dosing, fasting lipid levels were ordered and obtained by chart review. We compared baseline and alternate day dosing by Wilcoxon signed rank test.
Results: We evaluated 15 female patients with a mean age of 62 ± 14 years and BMI 26 ± 5 kg/m2. Overall, 60% had CVD, 60% had hypertension, 7% had diabetes, and 47% had a history of smoking but currently non-smokers. Prior to the study, all women were intolerant to 2 or more statins. Utilizing the alternate dosing NP protocol, we observed a 32% reduction in LDL-C, to a mean of 84 ± 39 mg/dl compared to the baseline mean of 134 ± 49 mg/dl (p<0.001)and a 20% reduction of TC (p<0.0001).
Conclusions: Among women with statin intolerance, an NP statin alternate dosing protocol is effective in reducing TC and LDL-C levels. Further studies using this protocol are warranted in larger statin intolerant populations.