Key result
Dose reductions, intermittent regimens, and nonstatin therapies offer effective options for statin intolerance.
Why the study?
Statin intolerance remains a challenging problem causing poor adherence and failure to lower cardiovascular risk despite statins' demonstrated safety and efficacy.
Supports individualized statin intolerance management; leaves open comparative effectiveness of nonstatin combinations in high-risk patients.
PURPOSE OF REVIEW: Hypercholesterolemia is a major risk factor for cardiovascular diseases. Administration of statins represents the cornerstone of the prevention and treatment of cardiovascular disease, with demonstrated long-term safety and efficacy. This review aims to revisit statin intolerance mechanisms, as well as to discuss new data and therapeutic options. RECENT FINDINGS: Although statins are well tolerated, myopathy and other adverse effects are a challenging problem, being the main reason for poor adherence to treatment and failure in lowering cardiovascular risk. Statin intolerance is the subject of ongoing research, as these drugs are widely used. There are alternative options of treatment if statin intolerance emerges, that is, lowering the dose, intermittent dosages, and/or combining a statin with other drugs, such as ezetimibe, proprotein convertase subtilisin-kexin type 9 inhibitors, bempedoic acid, angiopoietin-like 3 protein inhibitors, and nutraceuticals. If even the lowest statin dose cannot be tolerated, a nonstatin regimen is recommended to reduce LDL cholesterol levels. SUMMARY: Treatment options in statin intolerance include combinations of a lower dose of statin with other lipid-lowering regimens or only nonstatin drugs in the presence of complete intolerance. New hypolipidemic therapies that address gene editing are emerging, and may prove useful in the future.
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Diaconu et al. (2021) conducted a review in Statin intolerance and hypercholesterolemia. Alternative lipid-lowering therapies (ezetimibe, PCSK9 inhibitors, bempedoic acid, nutraceuticals) was evaluated. Treatment options for statin intolerance include lowering the statin dose, intermittent dosing, or utilizing nonstatin therapies such as ezetimibe, PCSK9 inhibitors, and bempedoic acid.
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