madman
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Statin Intolerance: A Review and Update (2023)
Yumiko Tsushima, MD, Betul Hatipoglu, MD
Abstract
Objective
To review the evidence of existing literature on the management of statin intolerance.
Methods
We searched for literature pertaining to statin intolerance and treatments in PubMed. We reviewed articles published between 2005 and 2022.
Results
Statin-associated myalgia is the most common adverse effect of statin therapy and the most common reason for statin discontinuation. The risk factors for statin intolerance include unexplained muscle pain with other lipid-lowering therapy, unexplained cramps, a history of increased creatine kinase levels, a family history of muscle symptoms, and a family history of muscle symptoms with lipid therapy. Vitamin D repletion and coenzyme Q supplementation may help alleviate the musculoskeletal effects of statins. Trials of different types of statins and different dosing regimens are recommended to improve tolerability. The use of statins in individuals who perform regular exercise requires closer attention to muscular symptoms and creatine kinase levels; however, it does not preclude the use of statins.
Conclusion
Management of the adverse effects of statin therapy and improving statin tolerability are key to achieving optimum cardiovascular benefits. Identifying statin-associated adverse effects and managing them appropriately can reduce unnecessary statin discontinuation and subsequently provide longer cardiovascular protection.
Introduction
Cardiovascular disease (CVD) is a leading cause of morbidity and mortality worldwide. A body of evidence accumulated over several decades has strengthened our understanding of circulating atherogenic lipoproteins, such as low-density lipoprotein (LDL) cholesterol, non-high-density lipoprotein cholesterol, and apolipoprotein B, and their roles in the pathogenesis of CVD. Statin therapy remains the first-line treatment for lowering CVD risk.1 However, clinicians face a dilemma when managing statin intolerance, having to either discontinue the statin therapy or lower the dosage below the optimum therapeutic dose.2 In this article, we review the evidence-based management of statin intolerance through 3 real-life cases.
*Defining Statin Intolerance
*Statin-Associated Myalgia
*Are There Treatment Options for SAM?
-Vitamin D
-Coenzyme Q10
*What Are the Adverse Effects of Statin Therapy?
-Myopathy/Rhabdomyolysis
-Liver Dysfunction
-Cognitive Impairment
-New-Onset Diabetes
*Current Guidelines for Management of Statin Intolerance
Conclusion
The benefits of statin therapy in the prevention of CVD are well established and the first-choice treatment for lowering LDL levels. However, discontinuation of statin therapy is common and mostly because of muscle-related adverse effects. Statin discontinuation has been associated with an increased risk of cardiovascular events. Therefore, statin-associated adverse effects must be assessed and managed promptly. Careful evaluation and treatment of underlying risk factors as well as trialing different statins and dosing regimens can improve statin tolerability. Statin therapy should not be given up easily because most individuals tolerate some type or dose of statin therapy. By preventing statin discontinuation, cardiovascular outcomes can be improved.
Yumiko Tsushima, MD, Betul Hatipoglu, MD
Abstract
Objective
To review the evidence of existing literature on the management of statin intolerance.
Methods
We searched for literature pertaining to statin intolerance and treatments in PubMed. We reviewed articles published between 2005 and 2022.
Results
Statin-associated myalgia is the most common adverse effect of statin therapy and the most common reason for statin discontinuation. The risk factors for statin intolerance include unexplained muscle pain with other lipid-lowering therapy, unexplained cramps, a history of increased creatine kinase levels, a family history of muscle symptoms, and a family history of muscle symptoms with lipid therapy. Vitamin D repletion and coenzyme Q supplementation may help alleviate the musculoskeletal effects of statins. Trials of different types of statins and different dosing regimens are recommended to improve tolerability. The use of statins in individuals who perform regular exercise requires closer attention to muscular symptoms and creatine kinase levels; however, it does not preclude the use of statins.
Conclusion
Management of the adverse effects of statin therapy and improving statin tolerability are key to achieving optimum cardiovascular benefits. Identifying statin-associated adverse effects and managing them appropriately can reduce unnecessary statin discontinuation and subsequently provide longer cardiovascular protection.
Introduction
Cardiovascular disease (CVD) is a leading cause of morbidity and mortality worldwide. A body of evidence accumulated over several decades has strengthened our understanding of circulating atherogenic lipoproteins, such as low-density lipoprotein (LDL) cholesterol, non-high-density lipoprotein cholesterol, and apolipoprotein B, and their roles in the pathogenesis of CVD. Statin therapy remains the first-line treatment for lowering CVD risk.1 However, clinicians face a dilemma when managing statin intolerance, having to either discontinue the statin therapy or lower the dosage below the optimum therapeutic dose.2 In this article, we review the evidence-based management of statin intolerance through 3 real-life cases.
*Defining Statin Intolerance
*Statin-Associated Myalgia
*Are There Treatment Options for SAM?
-Vitamin D
-Coenzyme Q10
*What Are the Adverse Effects of Statin Therapy?
-Myopathy/Rhabdomyolysis
-Liver Dysfunction
-Cognitive Impairment
-New-Onset Diabetes
*Current Guidelines for Management of Statin Intolerance
Conclusion
The benefits of statin therapy in the prevention of CVD are well established and the first-choice treatment for lowering LDL levels. However, discontinuation of statin therapy is common and mostly because of muscle-related adverse effects. Statin discontinuation has been associated with an increased risk of cardiovascular events. Therefore, statin-associated adverse effects must be assessed and managed promptly. Careful evaluation and treatment of underlying risk factors as well as trialing different statins and dosing regimens can improve statin tolerability. Statin therapy should not be given up easily because most individuals tolerate some type or dose of statin therapy. By preventing statin discontinuation, cardiovascular outcomes can be improved.
