Retrospective Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Exp Med. Feb 20, 2017; 7(1): 25-30
Published online Feb 20, 2017. doi: 10.5493/wjem.v7.i1.25
Statin escape phenomenon: Fact or fiction?
Fotios Barkas, Moses Elisaf, Eleftherios Klouras, Theodora Dimitriou, Nikolaos Tentolouris, Evangelos Liberopoulos
Fotios Barkas, Moses Elisaf, Eleftherios Klouras, Theodora Dimitriou, Evangelos Liberopoulos, Department of Internal Medicine, School of Medicine, University of Ioannina, 45110 Ioannina, Greece
Nikolaos Tentolouris, Evangelos Liberopoulos, First Department of Propaedeutic and Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, 10559 Athens, Greece
Author contributions: Barkas F designed and performed the research and wrote the paper; Klouras E and Dimitriou T contributed to the analysis; Tentolouris N provided clinical advice; Elisaf M and Liberopoulos E supervised the report.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of the University Hospital of Ioannina, Greece.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: Prof essor Elisaf M is an editorial member of World Journal of Experimental Medicine. The rest of authors have no conflict of interest relevant to this publication to declare.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Evangelos Liberopoulos, MD, PhD, FASA, FRSH, Assistant Professor of Internal Medicine, Department of Internal Medicine, School of Medicine, University of Ioannina, Stavrou Niarchou Avenue, 45110 Ioannina, Greece.
Telephone: +30-26-51099265 Fax: +30-26-51007016
Received: November 7, 2016
Peer-review started: November 10, 2016
First decision: December 1, 2016
Revised: December 10, 2016
Accepted: January 2, 2017
Article in press: January 3, 2017
Published online: February 20, 2017

To evaluate the presence of the so called “statin escape” phenomenon among hyperlipidemic subjects attending a lipid clinic.


This was a retrospective analysis of 1240 hyperlipidemic individuals followed-up for ≥ 3 years. We excluded those individuals meeting one of the following criteria: Use of statin therapy at baseline visit, discontinuation of statin treatment at most recent visit, change in statin treatment during follow-up and poor compliance to treatment. Statin escape phenomenon was defined as an increase in low-density lipoprotein cholesterol (LDL-C) levels at the most recent visit by > 10% compared with the value at 6 mo following initiation of statin treatment.


Of 181 eligible subjects, 31% exhibited the statin escape phenomenon. No major differences regarding baseline characteristics were found between statin escapers and non-statin escapers. Both escapes and non-escapes had similar baseline LDL-C levels [174 (152-189) and 177 (152-205) mg/dL, respectively]. In comparison with non-escapers, statin escapers demonstrated lower LDL-C levels at 6 mo after treatment initiation [88 (78-97) mg/dL vs 109 (91-129) mg/dL, P < 0.05], but higher levels at the most recent visit [103 (96-118) mg/dL vs 94 (79-114) mg/dL, P < 0.05].


These data confirm the existence of an escape phenomenon among statin-treated individuals. The clinical significance of this phenomenon remains uncertain.

Keywords: Statin, Escape, Cholesterol

Core tip: This was a retrospective study aiming to evaluate the presence of the so called “statin escape” phenomenon among hyperlipidemic subjects attending a lipid clinic and elucidate any potential confounding factors. This study confirms the limited bibliography reporting on statin escape phenomenon and its quite high prevalence. However, due to the small number of eligible participants, we were not able to identify potential predictors for the statin-escape phenomenon or establish an association between statin escape and incidence of cardiovascular disease. In this context, further investigation on the underlying pathophysiology of this phenomenon and its potential clinical ramifications is required.