Mar 03, 2016 the statinsmart website says 29% of people who take a statin develop statininduced myopathy, which they define as muscle aches, pains, weakness, or cramps. There is now overwhelming evidence to support lowering ldlc. The incidence of statin intolerance in clinical trials varies between 5 and 10%, whereas in observational studies the statin intolerance can be seen up to 20%. Oct 06, 2017 boston statin intolerance can be managed through various pathways for different patients, according to a presentation at the cardiometabolic health congress.
The profile of statin intolerance is described in table i. The recommendations represent a consensus of opinions of clinicians. That seems like a gross overestimate of the symptoms that are actually caused by statins, says dr. To maximise the benefits of statin therapy and avoid. Pharmacists letter includes 12 issues every year, with brief articles about new meds and hot topics. Acc statin intolerance app american college of cardiology. The definition of statin intolerance has evolved over the years. Treatment strategies in patients with statin intolerance. Statin intolerance journal of lipid and atherosclerosis. For example, atorvastatintreated subjects in the stomp study with. The acc statin intolerance app guides clinicians through the process of managing and treating patients who report muscle symptoms while on statin therapy. The prevalence of statin intolerance is also widely debated, in part because of. Share this article via email with one or more people using the form below. Statin intolerance in a patient with gilberts syndrome and.
Practical hints on dealing with statin intolerance. Now a solved problem statins are the most effective and widely used drugs for treating dyslipidemia, a major risk factor for coronary heart disease. Apr 03, 2016 statin intolerance has been a very challenging clinical problem, said steven nissen, m. There were a higher proportion of patients with pancreatitis significant elevation of serum. Dec 11, 2017 statin intolerance occurs when a person develops side effects from statin use. Follow steps to manage and treat a patient who reports muscle. Statin intolerance because of myalgia, myositis, myopathy, or.
But statins and muscle aches are now so thoroughly linked via word of mouth, and the food and drug administrationmandated voiceover disclaimers on tv. Discussion around statin discontinuation in older adults. Ascertainment of statin intolerance was inferred, not documented, and included events such as switching among 3 or more statins within a year or downtitration of a statin with addition of ezetimibe. As the name suggests, statin intolerance occurs when a patient is unable to continue to use a statin, either because of the development of a side effect or because of evidence on a blood test that certain markers of liver function or muscle function creatine kinase are sufficiently abnormal to cause concern. Insights into statin intolerance esperion therapeutics. Given the benefits of statins in ascvd risk reduction, clinicians should partner with the patient to gain a thorough symptom history and determine if he or she is. The national lipid association addresses the safety of. The most common is muscle pains or cramps, also called myalgias. This definition may underestimate the incidence of statin intolerance. Prescribers letter includes 12 issues every year, with brief articles about new meds and guidelines. We report a case of a 60yearold male receiving therapeutic imatinib for metastatic gastrointestinal tumour.
The vast majority of the time when we are talking about statin intolerance, we are talking about muscle aches and pains, and theres a number of really good clinical studies that have not found any statistically significant difference in muscle aches and pains between statin users and the people assigned to placebo. Various definitions of statin intolerance have been proposed, but in a broad sense it can be defined as an inability to tolerate a registered statin dose, due to adverse effects such as myalgiamyopathy, myositis, or elevation of serum liver enzyme activities. Evaluate evaluate possible intolerance to patients current statin prescription. Drug compare compare statin characteristics and drug interactions to determine the best cholesterollowering therapy. Disturbances in the acidbase balance, for example, in the setting of acidosis and. We excluded studies that included berberine or lovastatin.
Whilst it is well know that drugs that compete for cytochrome 450 system can result in myalgias there is sparse data on the role of glucuronidation of statins contributing to statin intolerance we report on a 60 year old male with hypercho. Boston statin intolerance can be managed through various pathways for different patients, according to a presentation at the cardiometabolic health congress. Practical recommendations for how to proceed in patients with statin intolerance. Managing statin intolerance in the hyperlipidemic patient there are many options that may allow a patient to benefit from statin therapy without incurring side effects. We conducted a search of four electronic databasespsycinfo, cinahl, pubmed, and scopususing the terms red yeast rice and cholesterol. Hence, there should be enough strategies for statin intolerant patients, so that they can be. Followup follow steps to treat and manage possible statinrelated muscle symptoms. Statin intolerance because of myalgia, myositis, myopathy, or myonecrosis can in most cases be safely resolved by vitamin d supplementation. Discontinuation and repetitive rechallenge with statins can help identify sams. In late 2014, the national lipid association nla defined this syndrome as an inability to tolerate at least two statinsone statin at the lowest starting daily dose and another statin at any daily dosedue to either objectionable symptoms real or perceived or abnormal laboratory determinations that are temporally related. The big problem with statins that medicare patients need to. This tool should be used by clinicians to assess, treat, and manage patients with possible statin intolerance. Kiran musunuru, assistant professor of medicine at harvard medical school.
A cohort study zhang h, plutzky j, skentzos s et al. The most common complaint of statin intolerance was myalgia, with a higher proportion in the statin intermittent group. Third, due to statin intolerance, when a patient cannot tolerate statin therapy either at a necessary dose or at all, and finally statin nonadherence because of poor patient compliance with statin medication. Work up validated questionnaire including fh of statin intolerance level of ck and vit. May 08, 2018 statin intolerance is a worldwide problem concerning the inability to tolerate a dose of statin required to sufficiently reduce cardiovascular cv risk. Statin intolerance because of myalgia, myositis, myopathy, or myonecrosis can in most cases be safely resolved by vitamin d supplementation maksim khayznikov, kallish hemachrandra, ramesh pandit, ashwin kumar, ping wang, charles j glueck department of internal medicine, the cholesterol, metabolism and thrombosis center, jewish hospital of cincinnati, cincinnati, ohio, usa. Many side effects attributed by patients to statins are in fact not. But a study released sunday shows for the first time that statin intolerance is very real and that a newer, different kind of drug can have a strong impact on these patients high cholesterol. Statin intolerance is a clinical syndrome characterized by the inability to tolerate at least 2 statins. Answer questions to evaluate possible intolerance to a patients current statin prescription. Statin intolerance is real, researchers find new haven. Now a solved problem p sikka 1, s kapoor 2, vk bindra 3, m sharma 1, p vishwakarma 1, kk saxena 1 1 department of pharmacology, llrm medical college, muradnagar, ghaziabad, india 2 department of oral pathology and microbiology, its cdsr, muradnagar, ghaziabad, india 3 department of medicine, idst, meerut, uttar pradesh, india. Statin intolerance is a worldwide problem concerning the inability to tolerate a dose of statin required to sufficiently reduce cardiovascular cv risk. Apr 28, 2011 after 6 weeks, ldlc was reduced by 38% and 20%, respectively with the resolution of adverse effects.
Oct 23, 2017 on the other hand statin intolerance starts out at about 15%. Whilst it is well know that drugs that compete for cytochrome 450 system can result in myalgias there is sparse data on the role of glucuronidation of statins contributing to statin intolerance we report on a. In a retrospective analysis of clinical charts at two lipid clinics,61 51 patients that had experienced statin intolerance were found to be treated with everyotherday rosuvastatin mean dose 5. This problem also confounds estimating the incidence and. Statin intolerance occurs when a person develops side effects from statin use. Mar 20, 2017 but statins and muscle aches are now so thoroughly linked via word of mouth, and the food and drug administrationmandated voiceover disclaimers on tv ads, that many statin users have come to. Toth1,2 angelo maria patti3 rosaria vincenza giglio3 dragana nikolic3 giuseppa castellino3 manfredi rizzo3 maciej banach4,5,6 published online. Apr 03, 2016 statin intolerance is real, researchers find. Statin intolerance objectively identified in patients. The big problem with statins that medicare patients need.
Here, we are discussing various options for statin intolerant hyperlipidemic patients such as lower and intermittent dosing of statins, alternate hypolipidemic drugs, red yeast rice, supplementation with coenzyme q10 and vitamin d. Pdf on jan 1, 2018, sunghwan suh and others published statin intolerance. Now a solved problem statins are the most effective and widely used drugs for treating dyslipidemia. However, the frequency of statinassociated adverse effects and statin intolerance in clinical practice is high up to 1015% of statin users. The study showed that pcsk9 inhibitors can significantly lower cholesterol in patients with documented statin intolerance, providing an effective treatment for these difficult to manage patients. Although the prevalence in our study is 4% of referrals, it is unlikely to be a true prevalence since it involves a selected population attending a. Statin intolerance has been a very challenging clinical problem, said steven nissen, m. Sikka p1, kapoor s, bindra vk, sharma m, vishwakarma p, saxena kk. Sas is favored over the term statin intolerance because many patients. Khayznikov m, hemachrandra k, pandit r, kumar a, wang p, glueck cj. D renal and thyroid function tests genetic testing for statin efficacy and potential toxicity proximal muscle strength evaluation percutaneous muscle biopsy 18. Peripheral neuropathy is a wellrecognised side effect of the cholesterollowering statins. This problem of statin intolerance is one of the most vexing problems for both patients and physicians in cardiovascular medicine, steven e.
Managing statin intolerance in the hyperlipidemic patient. Statin intolerance is real, researchers find new haven register. The current study has both strengths and weaknesses. The incidence of statin intolerance in the realworld situation is thought to be between 5% and 10%, 2,3 which is higher than that found in most clinical trials. Most cases of statin intolerance are related to patient complaints. Statin intolerance is not simply the occurrence of symptoms in general, but rather the symptoms that are perceived as unacceptable 27. Although muscle symptoms may occur, true statin intolerance is uncommon. Because statins are safe, the panel recommends that the clinician and patient should keep trying to adjust doses and type of statin in order to maintain statin therapy at some level when cardiovascular risk is high. The clinical spectrum of muscle and skeletalrelated sideeffects of statins includes varied myalgias and weakness, an asymptomatic increase in the concentration of creatine kinase and other biochemical parameters, myositis and rhabdomyolysis. The statinsmart website says 29% of people who take a statin develop statininduced myopathy, which they define as muscle aches, pains, weakness, or cramps. On the other hand statin intolerance starts out at about 15%. Statin discontinuation may concern the patients with complete statin intolerance, 8 as well as patients with cancer, palliative care patients, patients with cachexia, 9 but also elderly patients, and primary cv prevention individuals, in which the risk of statin. Red yeast rice ryr is a traditional chinese herb, widely available overthecounter that has also been found to reduce cholesterol.
D, of cleveland clinic discusses the steps for treatment if a patient is intolerant to a statin prescribed to lower cholesterol. Statin intolerance especially myalgias can be a serious problem. In statin studies, myopathy incidence varies but is generally thought to occur in 1. Currently, there is no consensus on the definition of statin myopathy. A patient being treated with a statin presents with muscle complaints and the question arises is it sams. The us fda now recommends a maximum dose of simvastatin 40 mg. Statin intolerance because of myalgia, myositis, myopathy. Choose a statin according to the extent of the necessary reduction of ldl cholesterol. Uncovering the truth about statin intolerance nps medicinewise. Treating statinintolerant patients pubmed central pmc. Because of high levels of cholesterol, these patients are in urgent need of alternate agents to effectively reduce the high levels. After 6 weeks, ldlc was reduced by 38% and 20%, respectively with the resolution of adverse effects. Baseline investigations for liver function and muscle toxicity should be done before initiating statin therapy.
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