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International Journal of Nursing & Clinical Practices Volume 3 (2016), Article ID 3:IJNCP-212, 3 pages
https://doi.org/10.15344/2394-4978/2016/212
Original Article
Alternate Day Statin Dosing for Women with Previous Statin Intolerance

Margo Minissian1*, Talya Waldman1, Chrisandra Shufelt1, Megha Agarwal4, Puja K. Mehta2, Galen Cook-Wiens1, Jo Ann Eastwood3 and Noel Bairey Merz1

1Barbra Streisand Women’s Heart Center, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, United States
2Emory Women’s Heart Center, Atlanta, Georgia, United States
3University of Los Angeles, School of Nursing, Los Angeles, California, United States
4Ventura Cardiology Consultants, Ventura, California, United States
Margo Minissian, PhDc, ACNP, Barbra Streisand Women’s Heart Center, Cedars-Sinai Heart Institute, 127 San Vicente AHSP suite A9306, Los Angeles, CA 90048, United States; E-mail: minissianm@cshs.org
29 September 2016; 01 December 2016; 03 December 2016
Minissian M, Waldman T, Shufelt C, Agarwal M, Mehta PK, et al. (2016) Alternate Day Statin Dosing for Women with Previous Statin Intolerance. Int J Nurs Clin Pract 3: 212. doi: https://doi.org/10.15344/2394-4978/2016/212
This work was supported by contracts from the National Heart, Lung and Blood Institutes:1F31NR015725-01, N01-HV-68161, N01- HV-68162, N01-HV-68163, N01-HV-68164, grants U0164829, U01 HL649141, U01 HL649241, T32HL69751, 1R03AG032631 from the National Institute on Aging, GCRC grant MO1-RR00425 from the National Center for Research Resources and grants from the Gustavus and Louis Pfeiffer Research Foundation, Danville, NJ, The Women’s Guild of Cedars-Sinai Medical Center, Los Angeles, CA, The Ladies Hospital Aid Society of Western Pennsylvania, Pittsburgh, PA, and QMED, Inc., Laurence Harbor, NJ, the Edythe L. Broad Women’s Heart Research Fellowship, Cedars-Sinai Medical Center, Los Angeles, California, and the Barbra Streisand Women’s Cardiovascular Research and Education Program, Cedars-Sinai Medical Center, Los Angeles.

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.