Abstract
Statins significantly reduce cardiovascular morbidity and mortality, nevertheless, adequate use of statins to reach LDL-cholesterol target values may be limited by adverse symptoms that lead to discontinuation or termination of treatment. The most common cause of statin intolerance and non-adherence to treatment is statin-associated myopathy (SAM).
SAM may be largely avoided by understanding the risk factors which increase the risk of SAM (rheumatological and neurological diseases, acute infections, hypothyroidism, old age, drug interactions and others), and, if they occur, by careful statin dose titration or by choice of statins with a lower risk of drug interactions. As there is neither a sufficiently sensitive and specific laboratory marker of SAM nor a specific examination method, a score system is recommended to assess the likelihood of SAM based on symptom characteristics (type of pain, association of the symptoms with statin therapy over time, including after withdrawal and re-challenge).
In statin-intolerant patients, statins should be administered according to a modified regimen with a potential for increasing the dose up to a tolerated maximum.