Statin Intolerance: Diagnosis and Remedies

Abstract 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

Angela Pirillo & Alberico Luigi Catapano

Curr Cardiol Rep (2015) 17:27

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