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Management of the statin-intolerant patient

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Opinion statement

Although the long- and short-term safety of statin therapy is well established, statin intolerance is common in clinical practice. Muscle symptoms are the most common side effect of statin therapy and are potentially the most hazardous and the most likely to reduce patient adherence. Clinicians can establish office protocols/procedures that will reduce the number of patients with statin intolerance. Genomic variations that result in statin-associated myopathy are likely. We await diagnostic and treatment options for this group. Alternative dosing options and the use of alternative statins are useful strategies for those with muscle symptoms. Therapeutic lifestyle changes are critical to achieving maximal risk reduction but remain difficult to implement. Presently available nonstatin lipid-lowering drugs (alone or in combination) do not have the established benefit of statins but do have potential benefit in select patients.

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References and Recommended Reading

  1. Baigent C, Keech A, Kearney PM, et al.: Cholesterol Treatment Trialists’ (CTT) Collaborators: Efficacy and safety of cholesterol-lowering treatment: prospective meta-analysis of data from 90,056 participants in 14 randomized trials of statins. Lancet 2005, 366:1267–1278.

    Article  PubMed  CAS  Google Scholar 

  2. Davidson MH, Robinson JG: Safety of aggressive lipid management. J Am Coll Cardiol 2007, 49:1753–1762.

    Article  PubMed  CAS  Google Scholar 

  3. McKenney JM, Davidson MH, Jacobson TA, Guyton JR: Final conclusions and recommendations of the National Lipid Association Statin Safety Assessment Task Force. Am J Cardiol 2006, 97(Suppl 1):S89–S94.

    Article  CAS  Google Scholar 

  4. Scott RS, Lintott CJ, Wilson MJ: Simvastatin and side effects. N Z Med J 1991, 104:493–495.

    PubMed  CAS  Google Scholar 

  5. Bruckert E, Hayem G, Dejager S, et al.: Mild to moderate muscular symptoms with high—dosage statin therapy in hyperlipidemic patients-the PRIMO study. Cardiovasc Drugs Ther 2005, 19:403–414.

    Article  PubMed  CAS  Google Scholar 

  6. Ballantyne CM, Herd A, Ferlic L, et al.: Heart Protection Study Collaborative Group: MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20,536 high-risk individuals: a randomised placebo-controlled trial. Lancet 2002, 360:7–22.

    Article  Google Scholar 

  7. Phillips PS, Hass RH, Bannykh S, et al.: Statin-associated myopathy with normal creatine kinase levels. Ann Intern Med 2002, 137:581–585.

    PubMed  Google Scholar 

  8. Marcoff L, Thompson PD: The role of coenzyme Q10 in statin-associated myopathy: a systematic review. J Am Coll Cardiol 2007, 49:2231–2237.

    Article  PubMed  CAS  Google Scholar 

  9. Caso G, Kelly P, McNurlan MA, Lawson WE: Effect of coenzyme Q10 on myopathic symptoms in patients treated with statins. Am J Cardiol 2007, 99:1409–1412.

    Article  PubMed  CAS  Google Scholar 

  10. Oh J, Ban MR, Miskie BA, et al.: Genetic determinants of statin intolerance. Lipids Health Dis 2007, 6:7.

    Article  PubMed  CAS  Google Scholar 

  11. Hansen KE, Hildebrand JP, Ferguson EE, et al.: Outcomes in 45 patients with statin-associated myopathy. Arch Intern Med 2005, 165:2671–2676.

    Article  PubMed  Google Scholar 

  12. Matalka MS, Ravnan MC, Deedwania PC: Is alternate daily dose of atorvastatin effective in treating patients with hyperlipidemia? The Alternate Day Versus Daily Dosing of Atorvastatin Study (ADDAS). Am Heart J 2002, 144:674–677.

    PubMed  CAS  Google Scholar 

  13. Backes JM, Moriarty PM, Ruisinger JF, Gibson CA: Effects of once weekly rosuvastatin among patients with a prior statin intolerance. Am J Cardiol 2007, 100:554–555.

    Article  PubMed  CAS  Google Scholar 

  14. Backes JM, Venero CV, Gibson CA, et al.: Effectiveness and tolerability of every-other-day rosuvastatin dosing in patients with prior statin intolerance. Ann Pharmacother 2008, 42:341–346.

    Article  PubMed  CAS  Google Scholar 

  15. Athyros VG, Tziomalos K, Kakafika AI, et al.: Effectiveness of ezetimibe alone or in combination with twice a week atorvastatin (10 mg) for statin intolerant high-risk patients. Am J Cardiol 2008, 101:483–485.

    Article  PubMed  CAS  Google Scholar 

  16. Jenkins DJA, Kendall CWC, Marchie A, et al.: Effects of a dietary portfolio of cholesterol-lowering foods vs lovastatin on serum lipids and C-reactive protein. JAMA 2003, 290:502–551.

    Article  PubMed  CAS  Google Scholar 

  17. Canner PL, Berge KG, Wenger NK, et al.: Fifteen year mortality in Coronary Drug Project patients: long term benefit with niacin. J Am Coll Cardiol 1986, 8:1245–1255.

    Article  PubMed  CAS  Google Scholar 

  18. Brown G, Albers JJ, Fisher LD, et al.: Regression of coronary artery disease as a result of intensive lipid-lowering therapy in men with high levels of apolipoprotein B. N Engl J Med 1990, 323:1289–1298.

    PubMed  CAS  Google Scholar 

  19. Zema MJ: Colesevelam HCl and ezetimibe combination therapy provides effective lipid-lowering in difficult-to-treat patients with hypercholesterolemia. Am J Ther 2005, 12:306–310.

    Article  PubMed  Google Scholar 

  20. Xydakis AM, Guyton JR, Chiou P, et al.: Effectiveness and tolerability of ezetimibe add-on therapy to a bile acid resin-based regimen for hypercholesterolemia. Am J Cardiol 2004, 94:795–797.

    Article  PubMed  CAS  Google Scholar 

  21. Rubins HB, Robins SJ, Collins D, et al.: Gemfibrozil for the secondary prevention of coronary heart disease in men with low levels of high-density lipoprotein cholesterol. N Engl J Med 1999, 341:410–418.

    Article  PubMed  CAS  Google Scholar 

  22. Scott R, O’Brien R, Fulcher G, et al.: Effects of fenofibrate treatment on cardiovascular disease risk in 9,795 individuals with type 2 diabetes and various components of the metabolic syndrome. Diabetes Care 2009, 32:493–498.

    Article  PubMed  CAS  Google Scholar 

  23. McKenney JM, Farnier M, Lo K-W, et al.: Safety and efficacy of long-term co-administration of fenofibrate and ezetimibe in patients with mixed hyperlipidemia. J Am Coll Cardiol 2006, 47:1584–1587.

    Article  PubMed  CAS  Google Scholar 

  24. Whitney EJ, Krasuski RA, Personius BE, et al.: A randomized trial of a strategy for increasing high-density lipoprotein cholesterol levels: effects on progression of coronary heart disease and clinical events. Ann Intern Med 2005, 142:95–104.

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Internal Medicine, Division of Cardiology, Emory University School of Medicine, 1527 Clifton Road Northeast, Atlanta, GA, 30322, USA

    William H. Smiley III

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  1. William H. Smiley III
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  2. Bobby V. Khan
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  3. Laurence S. Sperling
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Correspondence to William H. Smiley III.

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Smiley, W.H., Khan, B.V. & Sperling, L.S. Management of the statin-intolerant patient. Curr Treat Options Cardio Med 11, 263–271 (2009). https://doi.org/10.1007/s11936-009-0027-3

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