Management of Statin-Intolerant High-Risk Patients

Konstantinos      Tziomalos; Vasilios      G. Athyros; Asterios      Karagiannis; Dimitri      P. Mikhailidis

Abstract

Statins are an essential part of the management of patients at high vascular risk and are generally well-tolerated. However, statin intolerance will be observed more frequently as more stringent low density lipoprotein cholesterol (LDL-C) targets are pursued in an ever increasing number of patients. We review the management options for high-risk patients intolerant to statin treatment. Potential strategies include switching to a different statin, reducing the frequency of statin administration, substituting statins with other LDL-C-lowering agents (e.g. ezetimibe, colesevelam or nicotinic acid) and combining low-dose statin treatment with other lipid-modifying drugs. A limited number of studies specifically assessed statin-intolerant patients and most were small and of short duration. It is therefore difficult to make evidence-based recommendations for the management of this population. In addition, all treatment options have limitations in terms of safety and/or efficacy.

Keywords: Statins, myalgia, creatine kinase, transaminase, ezetimibe, nicotinic acid, colesevelam, fibrates, combination treatment