Management of statin-intolerant high-risk patients.
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.
Tziomalos
Konstantinos
K
Department of Clinical Biochemistry (Vascular Prevention Clinic) and Department of Surgery, Royal Free Campus, University College London Medical School, University College London (UCL), London, UK.
Athyros
Vasilios G
VG
Karagiannis
Asterios
A
Mikhailidis
Dimitri P
DP
D000924:Anticholesteremic Agents / Q000009:adverse effects / Q000627:therapeutic use; D000975:Antioxidants / Q000627:therapeutic use; D008078:Cholesterol, LDL / Q000097:blood; D019587:Dietary Supplements; D016903:Drug Monitoring; D004359:Drug Therapy, Combination / Q000009:adverse effects; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use*; D055118:Medication Adherence; D012307:Risk Factors; D014451:Ubiquinone / Q000031:analogs & derivatives / Q000627:therapeutic use; D014652:Vascular Diseases / Q000097:blood / Q000188:drug therapy* / Q000453:epidemiology*
D000924:Anticholesteremic Agents; D000975:Antioxidants; D008078:Cholesterol, LDL; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D014451:Ubiquinone; C024989:coenzyme Q10