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Management of Statin-Intolerant High-Risk Patients

[ Vol. 8 , Issue. 5 ]


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


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.


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


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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