Statin Intolerance: Diagnosis and Remedies

  • Angela PirilloEmail author
  • Alberico Luigi Catapano
Lipid Abnormalities and Cardiovascular Prevention (G De Backer, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Lipid Abnormalities and Cardiovascular Prevention


Despite the efficacy of statins in reducing cardiovascular events in both primary and secondary prevention, the adherence to statin therapy is not optimal, mainly due to the occurrence of muscular adverse effects. Several risk factors may concur to the development of statin-induced myotoxicity, including patient-related factors (age, sex, and race), statin properties (dose, lipophilicity, and type of metabolism), and the concomitant administration of other drugs. Thus, the management of patients intolerant to statins, particularly those at high or very high cardiovascular risk, involves alternative therapies, including the switch to another statin or the use of intermittent dosage statin regimens, as well as nonstatin lipid lowering drugs (ezetimibe and fibrates) or new hypolipidemic drugs such as PCSK9 monoclonal antibodies, the antisense oligonucleotide against the coding region of human apolipoprotein B mRNA (mipomersen), and microsomal triglyceride transfer protein inhibitor lomitapide. Ongoing clinical trials will reveal whether the lipid-lowering effects of alternative therapies to statins can also translate into a cardiovascular benefit.


Statins Statin intolerance Myopathy Myalgia 


Compliance with Ethics Guidelines

Conflict of Interest

Angela Pirillo has no conflicts of interest.

Alberico Luigi Catapano is on the advisory board or a member of the speaker bureau for AstraZeneca, Amgen, Aegerion, Eli-Lilly, Genzyme, Mediolanum, Merck-MSD, Pfizer, Recordati, Rottapharm, Sanofi, and Sigma-Tau.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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© Springer Science+Business Media New York 2015

Authors and Affiliations

  1. 1.Center for the Study of AtherosclerosisE. Bassini HospitalMilanItaly
  2. 2.IRCCS MultimedicaMilanItaly
  3. 3.Department of Pharmacological and Biomolecular SciencesUniversità degli Studi di MilanoMilanItaly

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