More than 40% were re-challenged with the same statin to which the adverse event was documented. At the 12-month follow-up, 37% of the patients re-challenged with the same statin were taking it at the same or a higher dose. On average, patients were re-challenged with 1.2 unique statins. While not included in the systematic evidence review and, thus, not considered in determining the strength of this recommendation, a second cohort study by Zhang et al. (2017) showed a lower incidence of death and CV events in patients who continued statins after an adverse reaction.[115] The authors examined 28,266 records of patients who had at least one presumed adverse reaction to a statin and found that patients who continued statins after a statin-related adverse event had a 0.9% absolute risk reduction (ARR) of CV events (95% CI: 0.1 1.7%) and 1.2% lower mortality over four years A retrospective cohort study of 1,605 patient records by Mampuya et al. (2013) evaluated the efficacy of intermittent statin dosing compared to daily dosing and statin discontinuation in patients with confirmed intolerance.[116] In this population, 63.2% of patients tolerated daily statin dosing, 9.3% tolerated intermittent dosing, and 27.5% discontinued statins. Intermittent dosing regimens ranged from once weekly to six days per week. Rosuvastatin was the most commonly used statin in the intermittent group, accounting for 75.2% of statin prescriptions. Both daily and intermittent dosing led to a significantly greater reduction in the surrogate endpoints of TC and LDL-C compared to statin discontinuation, with greater benefit from daily dosing. About 70% of studied patients were taking concomitant lipid-lowering prescription medications and supplements. 