Diagnosis and Management of Statin-Associated Muscle Symptoms

Statin-associated muscle symptoms (SAMS) are a common clinical challenge that often lead to poor adherence or discontinuation of statin therapy, thereby undermining its well-established cardiovascular benefits. This review explores the current understanding of the epidemiology, pathophysiology, clinical presentation, and diagnostic considerations of SAMS, with a particular focus on distinguishing true statin intolerance from nonspecific muscle complaints. We discuss evidence-based management strategies, including statin dose adjustment, rechallenge protocols, and the application of alternative lipid-lowering therapies such as ezetimibe, PCSK9 inhibitors, and bempedoic acid. Recent clinical trials support the efficacy and tolerability of combination therapy with moderate-intensity statins and ezetimibe, particularly in high-risk patients. A pragmatic, patient-centered approach is crucial for maintaining lipid-lowering therapy, minimizing adverse effects, and effectively reducing cardiovascular risk.