The prevalence of intolerance varies widely. Stopping statin therapy is associated with worse outcomes in patients with cardiovascular disease. Despite extensive studies, the benefits and risks of statins continue to be debated by clinicians and the lay public. We searched the PubMed, Medline, and Cochrane Central Register of Controlled Trials (CENTRAL) databases for all randomized controlled trials of statins compared with placebo. Studies were included if they had ≥1,000 participants, had patients who were followed up for ≥1 year, and reported rates of drug discontinuation. Studies were pooled as per the random effects model. A total of 22 studies (statins = 66,024, placebo = 63,656) met the inclusion criteria. The pooled analysis showed that, over a mean follow-up of 4.1 years, the rates of discontinuation were 13.3% (8,872 patients) for statin-treated patients and 13.9% (8,898 patients) for placebo-treated patients. The random effects model showed no significant difference between the placebo and statin arms (odds ratio Statin intolerance is a common phenomenon and is reported in 5% to 20% of patients, often resulting in drug discontinuation.[1 Stopping statin therapy has been associated with worsened outcomes in patients with cardiovascular diseases (CVDs).2 With acceptance of the latest American College of Cardiology guidelines, the number of patients who require treatment with statins has increased even further.3 A number of mechanisms have been proposed to explain the phenomenon of statin intolerance. However, despite extensive studies, statin intolerance remains an elusive phenomenon.Most of our knowledge of the incidence of statin intolerance stems from observational studies and post hoc analyses. Assessing statin intolerance is important, as it can have widespread implications on public health. A number of patients on statins report muscle-related symptoms. There is little consensus among clinicians on whether to attribute muscle symptoms to statins; and in the absence of confirming laboratory parameters, judgment frequently remains subjective. Given this backdrop, we conducted a rigorous meta-analysis of historical randomized controlled trials (RCTs) to compare the rates of drug discontinuation for patients treated with statins and for patients treated with placebo.
MethodsA PubMed and Medline literature search was conducted using the keywords "statin" and "clinical trials" (phase 1, phase 2, phase 3, and phase 4) as a filter. We also searched for "metaanalysis" as the article type and hand searched the reference lists of the selected systematic reviews to identify further studies. We also searched the Cochrane Central Register of Controlled Trials (CENTRAL) database to expand the literature search using the keywords "statin AND placebo." No language restrictions were applied and the databases were searched from the inception of these databases until October 2016.
Pheochromocytoma is a rare catecholamine secreting tumor. It has two types based on plasma catecholamines levels: 1) norepinephrine type and 2) mixed epinephrine-norepinephrine type. Few reports in the literature have documented the coexistence of pheochromocytoma with abdominal aortic aneurysm and proposed an association between them. In this report, we support these reports and present a case of norepinephrine type pheochromocytoma with concomitant aortic aneurysms. These aneurysms were found in the abdominal aorta, ascending, and descending thoracic aorta. That is unlike previous reports that had the aneurysms confined to the abdominal aorta. Uniquely, we suggest that this type of pheochromocytoma (the norepinephrine type) is associated with a more aggressive and extensive damage to the aortic walls. We also support that the etiology may be associated with the persistent elevation of catecholamines levels secreted from the tumor. Consequently, the aortic walls are damaged and become weak, predisposing them to aneurysm formation.
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