Statin Intolerance: a Review and Update.

OBJECTIVE: To review 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. Risk factors for statin intolerance include unexplained muscle pain with other lipid-lowering therapy, unexplained cramps, history of elevated creatinine kinase levels, family history of muscle symptoms, and 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 creatinine kinase levels, but it does not preclude the use of statins.

CONCLUSION: Management of the adverse effects of statin therapy and improving statin tolerability is key to achieving optimum cardiovascular benefits. Identifying statin-associated adverse effects and managing appropriately can reduce unnecessary statin discontinuation and subsequently provide longer cardiovascular protection.