Statin Intolerance: an Overview of US and International Guidance

Abstract

Purpose of review: To review recent international and domestic definitions, considerations, and treatment algorithms for statin intolerance, and specifically, statin-associated muscle symptoms (SAMS).

Recent findings: Multiple organizations around the world have produced guidance documents to aid clinicians on managing statin intolerance. A common theme resides among all the guidance documents that most patients can tolerate statins. For those patients who cannot, healthcare teams need to evaluate, rechallenge, educate, and ensure adequate reduction of atherogenic lipoproteins. Statin therapy remains the cornerstone of lipid-lowering therapies to reduce atherosclerotic cardiovascular disease (ASCVD) and reduce mortality and morbidity. The common theme throughout all these guidance documents is the importance of statin therapy to reduce ASCVD and continual adherence to treatment. Because adverse events occur and inhibit patients from achieving adequate lowering of their atherogenic lipoproteins, trial and rechallenge of statin therapy, as well as addition of non-statin therapies, especially in high-risk patients, is also undisputed. The main differences stem from laboratory monitoring and the classification of the severity of the adverse effect. Future research should focus on consistently diagnosing SAMS so that these patients can be easily identified in the electronic health records.

Keywords: Adherence; Cholesterol; Non-statin; Persistence; Statin; Statin intolerance.

Fig. 1

Latin America guidance algorithm for Statin Intolerance (reprinted from: Sposito AC, et al. Curr Med Res Opin. 2017; 33(2):239-51, with permission from Taylor and Francis Ltd., http://www.tandfonline.com/) [•]

Fig. 2

European Guidance algorithm for Statin Intolerance (reproduced from: Stroes et al. Eur Heart J. 2015; 36(17):1012-22, by permission of Oxford University Press) [•]

Fig. 3

Canadian guidance algorithm for Statin Intolerance (reprinted from: Mancini et al. Can J Cardiol. 2016; 32(7 Suppl):S35-65, with permission from Elsevier) [7]

Fig. 4

United States guidance algorithm for Statin Intolerance (reprinted from: Warden BA, et al. J Clin Lipidol. 2023 Jan-Feb;17(1):19-39, with permission from Elsevier) [••]