Statin intolerance: an updated, narrative review mainly focusing on muscle adverse effects

ABSTRACT

Introduction

Statins have been established as the standard of care for dyslipidemia and preventing cardiovascular diseases while posing few safety concerns. However, misconceptions about statin intolerance lead to their underuse, indicating a need to improve the understanding of the safety of this treatment.

Areas covered

We searched PubMed and reviewed literatures related to statin intolerance published between February 2015 and February 2020. Important large-scale or landmark studies published before 2015 were also cited as key evidence.

Expert opinion

Optimal lowering of low-density lipoprotein cholesterol with statins substantially reduces the risk of cardiovascular events. Muscle adverse events (AEs) were the most frequently reported AEs by statin users in clinical practice, but they usually occurred at a similar rate with statins and placebo in randomized controlled trials and had a spurious causal relationship with statin treatment. We proposed a rigorous definition for identifying true statin intolerance and present the criteria for defining different forms of muscle AEs and an algorithm for their management. True statin intolerance is uncommon, and every effort should be made to exclude false statin intolerance and ensure optimal use of statins. For the management of statin intolerance, statin-based approaches should be prioritized over non-statin approaches.

KEYWORDS:

• Cardiovascular disease
• definition
• dyslipidemia
• muscle toxicity
• mechanism
• management
• nonstatin
• Statin
• statin intolerance

Article highlights

• The benefits of cardiovascular disease (CVD) risk reduction by statins far outweigh any safety concerns

• Statin intolerance should be confirmed after rigorous examination

• Muscle adverse effects (AEs) are common complains in statin-treated patients but mostly do not suggest statin intolerance

• Managing muscle AEs involves iterative steps of assessment and adjustment

• Statin intolerance should be managed firstly by statin based approaches and then non-statin approaches

This box summarizes key points contained in the article.

Author contributions

HHL and NQW consulted literatures and drafted the manuscript. JJL developed the concept and structure of the article. KKY and SN made critical revisions of the article. All authors approved the final version to be submitted.

Acknowledgments

The authors would like to thank Dr Xinlei Yu of Nucleus Global for providing medical writing support, in accordance with Good Publication Practice (GPP3) guidelines.

Declarations of interest

P E Aylward declares that he has received research grants, advisory boards and speaker fees from AstraZeneca, CSL, Sanofi, Amgen, Merck. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Supplementary

Supplementary data for this article can be accessed here.