Review of Statin-Associated Symptoms, Definition and Diagnosis, and Treatment Strategies. An Australian Lipid Clinic experience

Abstract

Background: Statins are one of the most frequently prescribed medications in the reduction of cardiovascular disease. Although they are well-tolerated, there are known statin associated symptoms (SAS) that often result in discontinuation. The purpose of this article is to share an Australian lipid clinic experience with SAS, discuss possible management strategies and compare it with the existing literature. Method: A set of 306 patients were selected as a sample of the cohort that attended the lipid clinic at St Vincent's Hospital Melbourne from January 1995 to May 2014. Major journal articles, reviews and meta-analysis were identified in multiple databases from 1990 to 2017. Results: Seventy-eight patients (47.4%, 36 male, median age 73) referred with SAS were reviewed. Among SAS, SAMS was the most common (n = 42, 55.2%) followed by elevated creatinine kinase level (n = 19, 25.0%), then by hepatic enzymes derangement (n = 5, 6.6%). Management of SAS includes dose reduction and/or switching to a different statin, utilisation of alternate dosing regimens, and non-statin therapy. Following rechallenge, 68.4% (n = 52) of patients with SAS reported symptomatic improvement. 71.1% (n = 54) of patients could remain on regular statin therapy. There was a significant improvement in fasting lipid profiles with mean reduction in LDL-C by 38.7% (−1.28 mmol/L, p < 0.0001) with 27.6% (n = 21) of patients achieved target LDL-C levels (<2.6 mmol/L). Conclusion: Symptoms of statin intolerance are variable, however the most common were SAMS and CK elevation. Multiple statin treatment strategies exist and are effective in reducing SAS to improve both statin adherence and LDL-C profile.