title: Identification and management of patients with statin-associated symptoms in clinical practice: A clinician survey.
abstract: OBJECTIVE
  Discontinuation of statin therapy by patients with hypercholesterolemia because of the onset of side-effects (statin-associated symptoms [SAS]) increases the risk of cardiovascular morbidity and mortality. We aimed to understand how patients with SAS, particularly those with statin-associated muscle symptoms (SAMS), are identified and managed in the outpatient setting.
  
  
  METHODS
  A web-based survey involving 60 clinicians in each of 12 countries and 90 clinicians in the US was conducted. Clinicians answered questions about the diagnostic criteria, estimated incidence of SAS, and choice of treatment for patients with SAS.
  
  
  RESULTS
  Overall, 810 clinicians (78% cardiologists) completed the survey. An average of 72% of patients with potential SAS were reported to present with muscle-related symptoms (range across countries [RAC] 50-87%) that could be SAMS. Clinicians took a range of steps to confirm SAMS in these patients, including discontinuation of statin (average 59%; RAC 48-67%); re-challenge with ≥ 2 statins (average 74%; RAC 60-85%); modification of statin regimen (average 76%; RAC 65-85%); or a combination of these steps. Overall, 6% of patients with hypercholesterolemia were estimated to eventually have SAS (RAC 2-12%). In patients with SAS, on average 52% continued to receive a low-dose statin, usually with other lipid-lowering therapies (LLT). Of the remaining 49%, 38% received alternative LLT only; 11% did not receive any LLT.
  
  
  CONCLUSIONS
  There is some consistency and stringency in clinical practice for identifying patients with SAS; however, a structured work-up for identification, followed by a defined therapeutic algorithm, may improve their management.
authors.affiliation: Academic Medical Center, Department of Vascular Medicine, University of Amsterdam, Meibergdreef 9, Amsterdam 1105 AZ, The Netherlands. Electronic address: g.k.hovingh@amc.uva.nl.
authors.forename: G Kees
authors.initials: GK
authors.lastname: Hovingh
authors.affiliation: Amgen Inc., One Amgen Center Dr., MS 28-3-A, Thousand Oaks, CA 91320, USA.
authors.forename: Shravanthi R
authors.initials: SR
authors.lastname: Gandra
authors.affiliation: PRMA Consulting Ltd, Cygnus House, 1 Waterfront Business Park, Fleet, Hampshire GU51 3QT, UK.
authors.forename: Jan
authors.initials: J
authors.lastname: McKendrick
authors.affiliation: Amgen Inc., One Amgen Center Dr., MS 28-3-A, Thousand Oaks, CA 91320, USA.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Dent
authors.affiliation: PRMA Consulting Ltd, Cygnus House, 1 Waterfront Business Park, Fleet, Hampshire GU51 3QT, UK.
authors.forename: Heather
authors.initials: H
authors.lastname: Wieffer
authors.affiliation: Department of Pharmacological and Biomolecular Sciences, University of Milan and IRCCS Multimedica, Via Balzaretti 9, Milan 20133, Italy.
authors.forename: Alberico L
authors.initials: AL
authors.lastname: Catapano
authors.affiliation: Toronto Rehabilitation Institute, 347 Rumsey Road, Toronto, Ontario M4G 1R7, Canada.
authors.forename: Paul
authors.initials: P
authors.lastname: Oh
authors.affiliation: Mount Sinai Heart, Mount Sinai Icahn School of Medicine, 1425 Madison Ave, MC1 Level, New York 10029, USA.
authors.forename: Robert S
authors.initials: RS
authors.lastname: Rosenson
authors.affiliation: Academic Medical Center, Department of Vascular Medicine, University of Amsterdam, Meibergdreef 9, Amsterdam 1105 AZ, The Netherlands.
authors.forename: Erik S
authors.initials: ES
authors.lastname: Stroes
mesh_terms: D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000188:drug therapy* / Q000453:epidemiology; D003430:Cross-Sectional Studies; D005260:Female; D014943:Global Health; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D011795:Surveys and Questionnaires; D015996:Survival Rate / Q000639:trends
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors
keywords: Hypercholesterolemia; Statin; Statin intolerance; Statin-associated symptoms