Statin rebound or withdrawal syndrome: does it exist?

Studies in vascular cells in culture and in laboratory animals revealed that statin discontinuation triggers a rebound deterioration of vascular function. Retrospective studies of patients admitted with an acute coronary syndrome revealed that stopping statins during the first days of admission was associated with worse outcomes. In a prospective, randomized controlled trial in patients with a hemispheric ischemic stroke, stopping statins for 3 days was associated with a 4.7-fold increase in the risk of death or dependency, greater neurological deterioration, and a larger infarct volume. Discontinuing statins during the post-operative period following major vascular surgery was associated with a higher incidence of myocardial ischemia, nonfatal myocardial infarction, and cardiovascular death. However, no increase in adverse outcomes was observed in patients with stable chronic coronary artery disease following statin treatment discontinuation. Despite some study limitations, the bulk of the evidence suggests that under conditions of severe acute vascular stress, removal of statins must be contraindicated.