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Statin intolerance.

Ulrich Laufs1, Hubert Scharnagl, Winfried März

  • 1aKlinik Innere Medizin III (Kardiologie, Angiologie und Internistische Intensivmedizin), Universitätsklinikum des Saarlandes, Homburg, GermanybClinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, AustriacMedical Clinic V (Nephrology, Hypertensiology, Rheumatology, Endocrinology, Diabetology), Medical Faculty Mannheim, University of Heidelberg, HeidelbergdSynlab Academy, Synlab Services GmbH, Mannheim and Augsburg, Germany.

Current Opinion in Lipidology
|January 19, 2016
PubMed
Summary

Statin-associated muscle symptoms (SAMS) are a common side effect impacting patient adherence. Most patients can continue statin therapy with careful dose adjustment or combination treatments to manage SAMS effectively.

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Area of Science:

  • Cardiology
  • Pharmacology
  • Clinical Medicine

Background:

  • Hydroxymethylglutaryl-CoA reductase inhibitor (statin) therapy adherence is crucial for cardiovascular health.
  • Statin-associated muscle symptoms (SAMS) are the most frequent adverse effects, significantly hindering long-term treatment persistence.
  • SAMS negatively impact patient quality of life and, rarely, can progress to rhabdomyolysis.

Purpose of the Study:

  • To review current diagnostic and clinical work-up strategies for patients experiencing statin-associated muscle symptoms (SAMS).
  • To provide an overview of management approaches for SAMS to maintain statin therapy adherence.

Main Methods:

  • Literature review of current concepts in diagnosis and clinical management of SAMS.
  • Analysis of treatment strategies including statin re-challenge, dose titration, and combination therapies.

Main Results:

  • SAMS are a significant barrier to statin adherence, affecting quality of life.
  • The molecular basis of SAMS is diverse.
  • A primary treatment strategy involves cautious re-exposure to statins at very low doses with slow dose escalation.
  • This approach enables long-term statin treatment for the majority of patients.
  • For patients not achieving low-density lipoprotein (LDL) goals, combination therapy with ezetimibe or proprotein convertase subtilisin/kexin-9 inhibitors is an option.

Conclusions:

  • Addressing SAMS requires time and careful management to improve drug adherence.
  • Statin therapy can be continued for most patients experiencing SAMS.
  • Combination therapy is indicated when maximally tolerated statin doses fail to achieve LDL targets.