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Suggested clinical approach for the diagnosis and management of 'statin intolerance' with an emphasis on muscle-related side-effects.
Intern Med J. 2019 09; 49(9):1081-1091.IM

Abstract

Hyperlipidaemia is a major risk factor for cardiovascular morbidity and mortality. 3-hydroxy-3-methylglutaryl coenzyme-A reductase inhibitors ('statins') are first-line therapies for hyperlipidaemia. For each 1.0 mmoL/L reduction in low-density lipoprotein (LDL)-cholesterol, statins reduce the risk of major vascular events by 21% and all-cause mortality by 9%. Owing to their clinical effectiveness and excellent safety profile, many Australians are prescribed statins. There has been widespread reporting of possible side-effects, particularly muscle pains. Conversely, statin cessation relating to possible side-effects exposes patients to increased risk of vascular events and death. Although there is clinical consensus for diagnosing rare side-effects (e.g. myopathy or rhabdomyolysis), confirming that statins cause other less common side-effects (e.g. memory impairment) is difficult as strong randomised trial evidence related to statins and non-muscle-related side-effects is lacking. A stepwise approach to possible statin intolerance, consistent definitions and a simple flowchart may improve diagnosis and management. An increasing array of potential treatments is emerging, including intermittent statin dosing, new LDL-lowering drugs, LDL apheresis and supplements. Optimal statin use and management of statin intolerance should improve cardiovascular care and clinical outcomes.

Authors+Show Affiliations

National Health and Medical Research Council (NHMRC) Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia. Department of Cardiology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.National Health and Medical Research Council (NHMRC) Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia. Department of Cardiology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.NSW Health Pathology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.Department of Pharmacology, University of Tennessee, Knoxville, Tennessee, USA.National Health and Medical Research Council (NHMRC) Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia. Department of Medicine, University of Melbourne, St. Vincent's Hospital, Melbourne, Victoria, Australia.National Health and Medical Research Council (NHMRC) Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia. Department of Cardiology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

31507054

Citation

Sivashanmugarajah, Anosh, et al. "Suggested Clinical Approach for the Diagnosis and Management of 'statin Intolerance' With an Emphasis On Muscle-related Side-effects." Internal Medicine Journal, vol. 49, no. 9, 2019, pp. 1081-1091.
Sivashanmugarajah A, Fulcher J, Sullivan D, et al. Suggested clinical approach for the diagnosis and management of 'statin intolerance' with an emphasis on muscle-related side-effects. Intern Med J. 2019;49(9):1081-1091.
Sivashanmugarajah, A., Fulcher, J., Sullivan, D., Elam, M., Jenkins, A., & Keech, A. (2019). Suggested clinical approach for the diagnosis and management of 'statin intolerance' with an emphasis on muscle-related side-effects. Internal Medicine Journal, 49(9), 1081-1091. https://doi.org/10.1111/imj.14429
Sivashanmugarajah A, et al. Suggested Clinical Approach for the Diagnosis and Management of 'statin Intolerance' With an Emphasis On Muscle-related Side-effects. Intern Med J. 2019;49(9):1081-1091. PubMed PMID: 31507054.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Suggested clinical approach for the diagnosis and management of 'statin intolerance' with an emphasis on muscle-related side-effects. AU - Sivashanmugarajah,Anosh, AU - Fulcher,Jordan, AU - Sullivan,David, AU - Elam,Marshall, AU - Jenkins,Alicia, AU - Keech,Anthony, PY - 2018/11/14/received PY - 2019/05/24/revised PY - 2019/06/07/accepted PY - 2019/9/12/entrez PY - 2019/9/12/pubmed PY - 2020/4/16/medline KW - alternative therapy KW - cardiovascular disease KW - lipid KW - statin KW - statin intolerance SP - 1081 EP - 1091 JF - Internal medicine journal JO - Intern Med J VL - 49 IS - 9 N2 - Hyperlipidaemia is a major risk factor for cardiovascular morbidity and mortality. 3-hydroxy-3-methylglutaryl coenzyme-A reductase inhibitors ('statins') are first-line therapies for hyperlipidaemia. For each 1.0 mmoL/L reduction in low-density lipoprotein (LDL)-cholesterol, statins reduce the risk of major vascular events by 21% and all-cause mortality by 9%. Owing to their clinical effectiveness and excellent safety profile, many Australians are prescribed statins. There has been widespread reporting of possible side-effects, particularly muscle pains. Conversely, statin cessation relating to possible side-effects exposes patients to increased risk of vascular events and death. Although there is clinical consensus for diagnosing rare side-effects (e.g. myopathy or rhabdomyolysis), confirming that statins cause other less common side-effects (e.g. memory impairment) is difficult as strong randomised trial evidence related to statins and non-muscle-related side-effects is lacking. A stepwise approach to possible statin intolerance, consistent definitions and a simple flowchart may improve diagnosis and management. An increasing array of potential treatments is emerging, including intermittent statin dosing, new LDL-lowering drugs, LDL apheresis and supplements. Optimal statin use and management of statin intolerance should improve cardiovascular care and clinical outcomes. SN - 1445-5994 UR - https://www.unboundmedicine.com/medline/citation/31507054/Suggested_clinical_approach_for_the_diagnosis_and_management_of_'statin_intolerance'_with_an_emphasis_on_muscle_related_side_effects_ L2 - https://doi.org/10.1111/imj.14429 DB - PRIME DP - Unbound Medicine ER -