title: Diagnosis, prevention, and management of statin adverse effects and intolerance: Canadian Working Group Consensus update.
abstract: The Proceedings of a Canadian Working Group Consensus Conference, first published in 2011, provided a summary of statin-associated adverse effects and intolerance and management suggestions. In this update, new clinical studies identified since then that provide further insight into effects on muscle, cognition, cataracts, diabetes, kidney disease, and cancer are discussed. Of these, the arenas of greatest controversy pertain to purported effects on cognition and the emergence of diabetes during long-term therapy. Regarding cognition, the available evidence is not strongly supportive of a major adverse effect of statins. In contrast, the linkage between statin therapy and incident diabetes is more firm. However, this risk is more strongly associated with traditional risk factors for new-onset diabetes than with statin itself and any possible negative effect of new-onset diabetes during statin treatment is far outweighed by the cardiovascular risk reduction benefits. Additional studies are also discussed, which support the principle that systematic statin rechallenge, and lower or intermittent statin dosing strategies are the main methods for dealing with suspected statin intolerance at this time.
authors.affiliation: Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada. Electronic address: mancini@mail.ubc.ca.
authors.forename: G B John
authors.initials: GB
authors.lastname: Mancini
authors.forename: A Yashar
authors.initials: AY
authors.lastname: Tashakkor
authors.forename: Steven
authors.initials: S
authors.lastname: Baker
authors.forename: Jean
authors.initials: J
authors.lastname: Bergeron
authors.forename: David
authors.initials: D
authors.lastname: Fitchett
authors.forename: Jiri
authors.initials: J
authors.lastname: Frohlich
authors.forename: Jacques
authors.initials: J
authors.lastname: Genest
authors.forename: Milan
authors.initials: M
authors.lastname: Gupta
authors.forename: Robert A
authors.initials: RA
authors.lastname: Hegele
authors.forename: Dominic S
authors.initials: DS
authors.lastname: Ng
authors.forename: Glen J
authors.initials: GJ
authors.lastname: Pearson
authors.forename: Janet
authors.initials: J
authors.lastname: Pope
mesh_terms: D000465:Algorithms; D002318:Cardiovascular Diseases / Q000517:prevention & control*; D000075202:Contraindications; D004305:Dose-Response Relationship, Drug; D004347:Drug Interactions; D019317:Evidence-Based Medicine; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D006949:Hyperlipidemias / Q000188:drug therapy*; D009135:Muscular Diseases / Q000139:chemically induced / Q000175:diagnosis / Q000517:prevention & control; D010353:Patient Education as Topic; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors