Statin intolerance in questions and answers

Overview

Disorders of lipid and lipoprotein metabolism are among the most common metabolic diseases in general and it is not surprising that lipid-lowering therapies, especially statins, are among the most prescribed drugs in general. In the media, among the general public, but unfortunately often also among the professionals, numbers of serious adverse effects (AEs) of statins are discussed, with myopathy, myalgia or even rhabdomyolysis being the most frequently resonating in this context. It is statin-associated myopathy (SAM) that is considered statin intolerance sensu stricto; this will also be the focus of the following topic. Data on its prevalence vary considerably depending on the type of study on which they are based, i.e. the prevalence of SAM ranges between 0–29 %. Despite many efforts, there is still no marker that clearly demonstrates or predicts the possibility of developing SAM in a given patient. Although creatine kinase is frequently monitored in the context of possible statin intolerance, there is little correlation between its elevation and possible SAM. Genetic testing on the side of possible prediction of myalgia development has not gained significant importance (with the exception of simvastatin, but this is only marginally used statin). Its possible solution is to reduce the dose of the statin, to change the statin or to use an appropriate combination therapy. In most cases, the above interventions lead to the disappearance of difficulties and good tolerance of treatment, which in the future will result in the desired reduction of CV risk.

Keywords:

Myalgia – lipid-lowering therapy – statin intolerance – CV risk – creatine kinase – myopathy