[Statin intolerance-Statin tolerance]

Statins are the first-line treatment for reducing low-density lipoprotein (LDL) cholesterol levels, because the evidence regarding safety, tolerability, and reduction of cardiovascular morbidity and mortality is very good. For combination treatment several options are available. Nevertheless, LDL cholesterol values are often not sufficiently lowered. One reason is intolerance of the lipid-lowering medications.

In addition to the study situation regarding statin tolerability, possible approaches to overcome intolerability are also shown.

In randomized trials adverse effects due to statin treatment are as rare as in the placebo groups. In clinical practice patients more frequently report complaints, particularly muscular symptoms. One important reason for intolerability is the nocebo effect. Complaints during treatment can lead to the fact that statins are not taken or are taken in insufficient doses. As a result, the LDL cholesterol level is insufficiently lowered with unfavorable effects on the incidence of cardiovascular events. Therefore, it is important to establish a tolerable treatment together with the patient on an individual basis. Information about the facts is one important aspect. In addition, a positively guided communication with the patient helps to reduce the nocebo effect.

Most adverse effects that patients attribute to statins are not caused by statins. This shows that other reasons are frequent and should be the focus of medical care. In this article international recommendations and personal experiences of a specialized lipid outpatient clinic are described.