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Management of Statin-Intolerant High-Risk Patients

[ Vol. 8 , Issue. 5 ]

Author(s):

Konstantinos Tziomalos, Vasilios G. Athyros, Asterios Karagiannis and Dimitri P. Mikhailidis   Pages 632 - 637 ( 6 )

Abstract:


Statins are an essential part of the management of patients at high vascular risk and are generally well-tolerated. However, statin intolerance will be observed more frequently as more stringent low density lipoprotein cholesterol (LDL-C) targets are pursued in an ever increasing number of patients. We review the management options for high-risk patients intolerant to statin treatment. Potential strategies include switching to a different statin, reducing the frequency of statin administration, substituting statins with other LDL-C-lowering agents (e.g. ezetimibe, colesevelam or nicotinic acid) and combining low-dose statin treatment with other lipid-modifying drugs. A limited number of studies specifically assessed statin-intolerant patients and most were small and of short duration. It is therefore difficult to make evidence-based recommendations for the management of this population. In addition, all treatment options have limitations in terms of safety and/or efficacy.

Keywords:

Statins, myalgia, creatine kinase, transaminase, ezetimibe, nicotinic acid, colesevelam, fibrates, combination treatment

Affiliation:

Department of Clinical Biochemistry, Royal Free Hospital Campus, University College London Medical School, University College London (UCL), Pond Street, London NW3 2QG; UK.



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