Mayo Clinic: management of patients with statin intolerance

Cardiovascular disease is the leading cause of death in the USA today. The role of lipid-lowering therapy to help reduce risks associated with primary and secondary prevention of coronary artery disease is at the forefront of treatment. The 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors, or statins, have played a central role in the reduction of major adverse cardiac events, and are currently indicated for approximately 30 million people across the country. Although statins are generally well-tolerated, they are known to have myotoxic effects, ranging from self-limited muscle pain or cramping to rhabdomyolysis. Previous studies suggest 5-20% of patients on statin therapy will report such symptoms, often significant enough to prompt discontinuation of the medication. This review attempts to provide a framework for understanding statin intolerance by reviewing possible mechanisms, identifying patients at risk and discussing the preferred treatment approach utilized by the Mayo Clinic's Statin Intolerance Clinic (MN, USA).