Management of Statin Intolerant Patients in the Era of Novel Lipid Lowering Therapies: A Critical Approach in Clinical Practice
Abstract
:1. Introduction
2. Methodology for Literature Searching
3. Statin Intolerance
3.1. Definition and Clinical Manifestations
3.2. Statin Intolerance and Cardiovascular Events
4. Management of Statin Intolerance
- -
- Switch
- -
- Lower dose
- -
- Alternate dosage regimen
- -
- Polypharmacy
5. Non-Statin Lipid Lowering Treatments
5.1. Ezetimibe
5.2. PCSK9 Inhibitors
5.3. Bempedoic Acid
5.4. Nutraceuticals
5.5. Other Therapeutic Strategies for LDL-C Reduction
6. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Statin-Associated Side Effects (SASE) | Frequency |
---|---|
Statin-Associated Muscle Symptom (SAMS) | |
| Infrequent (1–5%) in RCTs; frequent (5–10%) in observational studies and in clinical practice |
| Rare |
| Rare |
| Rare |
New onset diabetes mellitus | It depends on population. Frequency increases in the presence of diabetes mellitus risk factors, such as BMI ≥ 30, fasting blood glucose ≥ 100, metabolic syndrome, HbA1c ≥ 6% |
Hepatic injury | |
| Infrequent |
| Rare |
Central nervous system | |
| Rare |
Cancer | No clear association |
Kidney disease | No clear association |
Cataract | No clear association |
Tendon rupture | No clear association |
Haemorrhagic stroke | No clear association |
Interstitial lung disease | No clear association |
Hypogonadism | No clear association |
Endogenous Risk Factors | Exogenous Risk Factor |
---|---|
Elderly | Intensive physical activity |
Female sex | High intensity statin therapy |
Asian ethnicity | Alcohol abuse |
Positive history of muscle and/or joint pain | Drug abuse |
Inflammatory or metabolic neuromuscular disease
| Drug interactions
|
Positive history of increased CK (especially if CK > 10 ULN) | Grapefruit or blueberry juice consumption (>1 L/day) |
Positive family history of myopathy | Unregulated supplements (e.g., red yeast rice, pleurotus mushrooms, etc.). |
Induced myopathy by statins or other hypolipidemic drugs | Surgical procedures |
Low body mass index | |
Severe kidney failure (III-IV stage KDOQI) | |
Acute or decompensated hepatopathy | |
Hypertension/heart failure (secondary to kidney disease) | |
Untreated or undertreated hypothyroidism | |
Diabetes mellitus | |
Acute infection | |
Biliary obstruction | |
Major trauma with increased metabolic demand | |
Vitamin D deficiency | |
Genetic polymorphisms
|
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Bosco, G.; Di Giacomo Barbagallo, F.; Spampinato, S.; Lanzafame, L.; Di Pino, A.; Piro, S.; Purrello, F.; Scicali, R. Management of Statin Intolerant Patients in the Era of Novel Lipid Lowering Therapies: A Critical Approach in Clinical Practice. J. Clin. Med. 2023, 12, 2444. https://doi.org/10.3390/jcm12062444
Bosco G, Di Giacomo Barbagallo F, Spampinato S, Lanzafame L, Di Pino A, Piro S, Purrello F, Scicali R. Management of Statin Intolerant Patients in the Era of Novel Lipid Lowering Therapies: A Critical Approach in Clinical Practice. Journal of Clinical Medicine. 2023; 12(6):2444. https://doi.org/10.3390/jcm12062444
Chicago/Turabian StyleBosco, Giosiana, Francesco Di Giacomo Barbagallo, Salvatore Spampinato, Lorena Lanzafame, Antonino Di Pino, Salvatore Piro, Francesco Purrello, and Roberto Scicali. 2023. "Management of Statin Intolerant Patients in the Era of Novel Lipid Lowering Therapies: A Critical Approach in Clinical Practice" Journal of Clinical Medicine 12, no. 6: 2444. https://doi.org/10.3390/jcm12062444