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Statin intolerance management: a systematic review

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Abstract

Background

Statin intolerance is a key barrier to the effective prevention of atherosclerotic cardiovascular disease (ASCVD). Experts do not agree on what it is and how to respond to this problem clinically.

Objective

To characterize the range of expert recommendations about the care of patients with statin intolerance.

Methods

Systematic review registered in PROSPERO that searched on April 1 2022 in PubMed, EMBASE, Scopus, Cochrane, online textbooks, and specialty textbooks for expert reviews (e.g., review articles and book chapters), systematic reviews, or clinical practice guidelines published in the past 5 years without language restriction. Authors working in duplicate extracted definitions, management recommendations, and supportive evidence cited.

Results

We identified 26 eligible articles, none of which described a systematic method to summarize the evidence or to develop and grade recommendations. Of these, 14 (54%) offered a definition of statin intolerance. A sequenced approach to management of statin intolerance was suggested in 24 (92%) articles describing 12 different approaches without supporting evidence of efficacy. Investigating for other causes was the most common first step. All authors suggested rechallenging after a washout period with either the same or other statin. Few considered nonlipid approaches to reducing ASCVD risk and none recommended involving patients in shared decision making.

Conclusion

We found substantial variability in the definition and management of statin intolerance among experts. Few focused on ASCVD risk reduction and none promoted the participation of patients in shared decision making about how to address the threat of ASCVD with or without statins.

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Author information

Authors and Affiliations

  1. Facultad de Medicina Humana, Universidad Peruana de Ciencias Aplicadas, Lima, Peru

    Alejandra Meza-Contreras

  2. Knowledge and Evaluation Research Unit, Department of Medicine, Mayo Clinic, Rochester, MN, USA

    Camila Wenczenovicz & Victor M. Montori

  3. Facultad de Medicina, Universidad Peruana Cayetano Heredia, Lima, Peru

    Kim Ruiz-Arellanos

  4. Health Sciences Library, Mayo Clinic, Rochester, MN, USA

    Elissa A. Kinzelman Vesely

  5. University of Nevada Reno, Internal Medicine Program, Reno, NV, USA

    Renzo Mogollon

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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by C.W., K.R.-A., R.M., A.M.-C., and V.M.M. E.A.K.V. along with the other authors performed the literature search. The first draft of the manuscript was written by A.M.-C. and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Victor M. Montori.

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Conflict of interest

The authors declare no financial conflicts of interest. V.M.M. participates in the design, development, implementation, evaluation, and dissemination of shared decision making tools. Neither V.M.M. nor the Knowledge and Evaluation Research receive for-profit funding for this work or derive income from the shared decision making tools that result from it which are placed in the public domain for free use at http://carethatfits.org.

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Meza-Contreras, A., Wenczenovicz, C., Ruiz-Arellanos, K. et al. Statin intolerance management: a systematic review. Endocrine 79, 430–436 (2023). https://doi.org/10.1007/s12020-022-03263-w

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