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Management of Statin Intolerance

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Therapeutic Lipidology

Part of the book series: Contemporary Cardiology ((CONCARD))

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Abstract

Statins reduce circulating concentrations of low-density lipoprotein cholesterol (LDL-C) and thereby are effective at reducing cardiovascular (CV) events and mortality in primary and secondary prevention. As with all drugs, statins cause adverse effects in some patients. Statin intolerance occurs when adverse effects limit the maximum dose of statin (partial statin intolerance) or cause patients to cease statin therapy (complete statin intolerance). Statin intolerance is associated with poor clinical outcomes; however, many patients (even 90–95%) who initially report intolerance can tolerate some degree of statin therapy. In order that all patients receive optimal lipid-lowering therapy, it is essential that the relatively small number of patients with true intolerance is differentiated from those with symptoms misattributed to statin therapy (the drucebo effect). This chapter provides an overview of the diagnosis of statin intolerance and provides management advice aimed at achieving optimal lipid-lowering in these patients. Approaches such as dose reduction, alternate-day dosing, and add-on drugs and nutraceuticals can be effective in reaching this aim.

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Abbreviations

ACL:

ATP-citrate lyase

ACS:

Acute coronary syndromes

ACSVL1:

Very-long-chain acyl CoA synthetase-1

ASCVD:

Atherosclerotic cardiovascular disease

CAD:

Coronary artery disease

CHD:

Coronary heart disease

CK:

Creatine kinase

CKD:

Chronic kidney disease

CVD:

Cardiovascular disease

DM:

Diabetes mellitus

EAS:

European Atherosclerosis Society

FABP3:

Fatty acid-binding protein 3

FOURIER:

Further Cardiovascular Outcomes Research with PCSK9 Inhibition in Subjects with Elevated Risk

HDL-C:

High-density lipoprotein cholesterol

HMG-CoA:

3-Hydroxy-3-methylglutaryl coenzyme A

ILEP:

International Lipid Expert Panel

LDL-C:

Low-density lipoprotein cholesterol

Lp(a):

Lipoprotein(a)

MI:

Myocardial infarction

MLC1:

Myosin light chain 1

NLA:

National Lipid Association

NOD:

New-onset diabetes

ODYSSEY Outcomes:

Evaluation of Cardiovascular Outcomes After an Acute Coronary Syndrome During Treatment With Alirocumab

PCSK9:

Proprotein convertase subtilisin/kexin type 9

RCTs:

Randomized controlled trials

SAMS:

Statin-associated muscle symptoms

SMCI:

Statin Myalgia Clinical Index

TG:

Triglycerides

ULN:

Upper limit of normal

USAGE:

The Understanding Statin Use in America and Gaps in Patient Education

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Author information

Authors and Affiliations

  1. Department of Hypertension, Medical University of Lodz, Lodz, Poland

    Marcin A. Bartlomiejczyk & Maciej Banach

  2. School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Liverpool, UK

    Peter E. Penson

  3. Polish Mother’s Memorial Hospital Research Institute (PMMHRI), Lodz, Poland

    Maciej Banach

Authors
  1. Marcin A. Bartlomiejczyk
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  2. Peter E. Penson
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  3. Maciej Banach
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Editor information

Editors and Affiliations

  1. The University of Chicago Pritzker School of Medicine, Chicago, IL, USA

    Michael H. Davidson

  2. Cicarrone Center for the Prevention of Cardiovascular Disease, Johns Hopkins Univerity School of Medicine, Baltimore, MD, USA

    Peter P. Toth

  3. Department of Applied Health Science, Indiana University School of Public Health, Bloomington, IN, USA

    Kevin C. Maki

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Bartlomiejczyk, M.A., Penson, P.E., Banach, M. (2021). Management of Statin Intolerance. In: Davidson, M.H., Toth, P.P., Maki, K.C. (eds) Therapeutic Lipidology. Contemporary Cardiology. Humana, Cham. https://doi.org/10.1007/978-3-030-56514-5_12

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