title: Statin intolerance: diagnosis and remedies.
abstract: Despite the efficacy of statins in reducing cardiovascular events in both primary and secondary prevention, the adherence to statin therapy is not optimal, mainly due to the occurrence of muscular adverse effects. Several risk factors may concur to the development of statin-induced myotoxicity, including patient-related factors (age, sex, and race), statin properties (dose, lipophilicity, and type of metabolism), and the concomitant administration of other drugs. Thus, the management of patients intolerant to statins, particularly those at high or very high cardiovascular risk, involves alternative therapies, including the switch to another statin or the use of intermittent dosage statin regimens, as well as nonstatin lipid lowering drugs (ezetimibe and fibrates) or new hypolipidemic drugs such as PCSK9 monoclonal antibodies, the antisense oligonucleotide against the coding region of human apolipoprotein B mRNA (mipomersen), and microsomal triglyceride transfer protein inhibitor lomitapide. Ongoing clinical trials will reveal whether the lipid-lowering effects of alternative therapies to statins can also translate into a cardiovascular benefit.
authors.affiliation: Center for the Study of Atherosclerosis, E. Bassini Hospital, Via M. Gorki 50, Cinisello Balsamo, Milan, Italy, angela.pirillo@guest.unimi.it.
authors.forename: Angela
authors.initials: A
authors.lastname: Pirillo
authors.forename: Alberico Luigi
authors.initials: AL
authors.lastname: Catapano
mesh_terms: D000818:Animals; D000924:Anticholesteremic Agents / Q000009:adverse effects*; D002318:Cardiovascular Diseases / Q000517:prevention & control*; D019587:Dietary Supplements; D000069438:Ezetimibe / Q000009:adverse effects; D058607:Fibric Acids / Q000009:adverse effects; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000009:adverse effects*; D000960:Hypolipidemic Agents / Q000009:adverse effects*; D063806:Myalgia / Q000139:chemically induced*; D009841:Oligonucleotides / Q000009:adverse effects; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors
chemical_list: D000924:Anticholesteremic Agents; D058607:Fibric Acids; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D000960:Hypolipidemic Agents; D009841:Oligonucleotides; C524142:mipomersen; D000069438:Ezetimibe