Overcoming toxicity and side-effects of lipid-lowering therapies.
Lowering serum lipid levels is part of the foundation of treating and preventing clinically significant cardiovascular disease. Recently, the American Heart Association/American College of Cardiology released cholesterol guidelines which advocate for high efficacy statins rather than LDL-c goals for five patient subgroups at high risk for cardiovascular disease. Therefore, it is critical that clinicians have an approach for managing side-effects of statin therapy. Statins are associated with myopathy, transaminase elevations, and an increased risk of incident diabetes mellitus among some patients; connections between statins and other processes, such as renal and neurologic function, have also been studied with mixed results. Statin-related adverse effects might be minimized by careful assessment of patient risk factors. Strategies to continue statin therapy despite adverse effects include switching to another statin at a lower dose and titrating up, giving intermittent doses of statins, and adding non-statin agents. Non-statin lipid-lowering drugs have their own unique limitations. Management strategies and algorithms for statin-associated toxicities are available to help guide clinicians. Clinical practice should emphasize tailoring therapy to address each individual's cholesterol goals and risk of developing adverse effects on lipid-lowering drugs.
University of Chicago, Department of Medicine, Chicago, IL, USA. Electronic address: michael.wilkinson@uchospitals.edu.
Michael J
MJ
Wilkinson
University of Chicago, Department of Medicine, Chicago, IL, USA. Electronic address: luke.laffin@uchospitals.edu.
Luke J
LJ
Laffin
University of Chicago, Department of Medicine, Chicago, IL, USA. Electronic address: mdavidso@bsd.uchicago.edu.
Michael H
MH
Davidson
D056486:Chemical and Drug Induced Liver Injury / Q000628:therapy; D004305:Dose-Response Relationship, Drug; D064420:Drug-Related Side Effects and Adverse Reactions / Q000150:complications / Q000628:therapy*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage / Q000009:adverse effects; D000960:Hypolipidemic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D007674:Kidney Diseases / Q000139:chemically induced / Q000628:therapy; D009135:Muscular Diseases / Q000139:chemically induced / Q000628:therapy; D009422:Nervous System Diseases / Q000139:chemically induced / Q000628:therapy; D012307:Risk Factors
D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D000960:Hypolipidemic Agents
atherosclerosis; cardiovascular diseases; drug toxicity; hydroxymethylglutaryl-CoA reductase inhibitors; hypercholesterolemia; lipoproteins