Determination and current management options for statin intolerance
Authors:
Lukáš Olšavský 1; Štefan Tóth 2; Adriána Jarolímková 1
Authors‘ workplace:
Klinika všeobecného lekárstva LF UPJŠ a Nemocnice AGEL Košice-Šaca a. s.
1; Kardiologická ambulancia, Kardiocomp s. r. o., Košice
2
Published in:
AtheroRev 2025; 10(1): 23-29
Category:
Reviews
Overview
Statin intolerance represents a significant challenge in the treatment of dyslipidemia, particularly in patients with high cardiovascular risk. This condition, defined as the inability of a patient to tolerate a statin dose required for effective LDL cholesterol reduction, can result from muscle symptoms, elevated liver enzymes, or other adverse effects. The prevalence of statin intolerance ranges from 7 % to 29 % in clinical practice, with complete intolerance observed in only 3–6 % of patients. Mild forms of muscle symptoms, such as myalgia, are the most common, while severe complications like rhabdomyolysis are very rare. The diagnosis of statin intolerance involves evaluating the temporal relationship between the onset of therapy and symptoms, excluding alternative causes, and confirming causality through rechallenge with the drug. An interesting phenomenon is the nocebo effect, which may account for the majority of subjective complaints of muscle symptoms without a direct link to statins. The management of patients with statin intolerance includes non-pharmacological approaches, such as lifestyle modifications, and pharmacological alternatives, including ezetimibe, PCSK9 inhibitors, and novel drugs like inklisiran. Inklisiran, an RNA interference-based drug, offers a significant reduction in LDL cholesterol of over 50 % with only biannual dosing and minimal side effects.
Keywords:
management – dyslipidemia – determination – statin intolerance– symptoms
Sources
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