New insights into statin-intolerance: biopsychosocial differences, medication beliefs, trust in healthcare and treatment decisions in statin-intolerant versus statin-tolerant patients.

AIMS: This study examined biopsychosocial differences between statin-intolerant and statin-tolerant patients, including their medication beliefs, healthcare trust and influential factors for treatment decisions. METHODS: A cross-sectional survey study was conducted among current and former statin-users. Data on demographics, comorbidities, psychosocial factors, medication beliefs, trust in healthcare and factors influencing treatment decisions was collected. Statin-intolerance was classified according to the National Lipid Association definition. RESULTS: Of 1,019 participants (median 66 years, 59% men), 178 (17%) were classified as statin-intolerant. In a multivariable binary logistic regression model (odds ratio, 95% confidence interval), the demographic and biological factors female sex (1.52, 1.05-2.19), atherosclerotic cardiovascular disease diagnosis (1.97, 1.39-2.80), musculoskeletal disease diagnosis (1.93, 1.17-3.15) and gastro-intestinal disease diagnosis (1.92, 1.01-3.52) were associated with statin-intolerance, but not psychosocial factors. Statin-intolerant vs statin-tolerant respondents held a more negative general view of medication (overuse 11 [9-13] vs. 10 [8-12], p=0.03; harms 9 [8-11] vs. 8 [7-10], p=0.02) and of statins (necessity 13 [11-16] vs. 15 [13-17], p<0.001; concerns 13 [11-16] vs. 11 [10-13], p<0.001), reported lower trust in healthcare professionals (42 [37-46] vs. 44 [38-48], p=0.02) and prioritized experienced side-effects (91 [76-99] vs. 45 [10-70], p<0.001) over benefits (effect on lipid-levels 65 [41-85] vs. 77 [50-93], p<0.001) in their statin-treatment decision. CONCLUSIONS: Statin-intolerant patients differ from statin-tolerant patients in demographic and biological characteristics, medication beliefs and healthcare trust. They prioritize negative factors in treatment decisions, underscoring importance of early communication on statin benefits and alternative symptom causes.