Statin-Related Myotoxicity: A Narrative Review and Practical Approach for General Internists

Statins constitute a common class of therapeutic agents indicated for the treatment of hyperlipidaemia, cerebrovascular, and cardiovascular disease. Statins are widely used due to their well-established cardiovascular benefits, pleiotropic effects (e.g. atherosclerotic plaque-stabilising effects), and favourable safety profile. Yet, with its widespread usage, clinicians should be aware of its common side effect in the form of statin-associated muscular symptoms that potentially develop in 5-10% of patients. While most of these adverse effects are benign and amenable to dose reduction or switching to an alternative statin, rare cases occur where patients develop severe myopathies, rhabdomyolysis, and even a potentially dangerous form of autoimmune necrotising myositis. In this narrative review article, we sought to provide a practical and up-to-date overview and approach to statin-associated myotoxicity for general internists who would manage these patients in their practice.