Ulrich Laufs1, Krysztof J Filipiak2, Ioanna Gouni-Berthold3, Alberico L Catapano4. 1. Department of Internal Medicine III, Cardiology, Angiology and Intensive Care Medicine, Saarland University Medical Center, Homburg, Germany. Electronic address: Ulrich.Laufs@uniklinikum-saarland.de. 2. First Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland. 3. Polyclinic for Endocrinology, Diabetes and Preventive Medicine, University of Cologne, Cologne, Germany. 4. Department of Pharmacological and Biomolecular Sciences, University of Milan, and IRCCS Multimedica, Milan, Italy.
Abstract
BACKGROUND AND AIMS: Statin-associated muscle symptoms (SAMS) frequently cause statin non-adherence, switching and discontinuation, contributing to adverse cardiovascular (CV) outcomes. Therefore, the management of SAMS is key in the effective treatment of patients with cardiovascular disease (CVD), through achievement of maximum-tolerated statin dosing and other practical aspects. The aim of this article is to provide practical, focused advice for healthcare professionals on the management of patients with SAMS. METHODS: An expert working group combined current evidence, published guidelines and experiences surrounding a number of topics concerning SAMS to provide recommendations on how to best assess and manage this condition and reach the highest tolerated dose of statin for each individual patient. RESULTS: The group collaborated to provide guidance on definitions in the SAMS field, psychological issues, re-challenging and switching treatments, as well as interpretation of current guidelines and optimal treatment of SAMS in different patient populations. An algorithm was developed to guide the management of patients with SAMS. In addition, the expert working group considered some of the more complex scenarios in a series of frequently asked questions and suggested answers. CONCLUSIONS: The expert working group gave recommendations for healthcare professionals on the management of SAMS but highlighted the importance of tailoring the treatment approach to each individual patient. Evidence supporting the role of nutraceuticals and complementary therapies, such as vitamin D, was lacking, however the majority of the group favoured combination therapy with ezetimibe and the addition of PCSK9 inhibitors in high-risk patients.
BACKGROUND AND AIMS: Statin-associated muscle symptoms (SAMS) frequently cause statin non-adherence, switching and discontinuation, contributing to adverse cardiovascular (CV) outcomes. Therefore, the management of SAMS is key in the effective treatment of patients with cardiovascular disease (CVD), through achievement of maximum-tolerated statin dosing and other practical aspects. The aim of this article is to provide practical, focused advice for healthcare professionals on the management of patients with SAMS. METHODS: An expert working group combined current evidence, published guidelines and experiences surrounding a number of topics concerning SAMS to provide recommendations on how to best assess and manage this condition and reach the highest tolerated dose of statin for each individual patient. RESULTS: The group collaborated to provide guidance on definitions in the SAMS field, psychological issues, re-challenging and switching treatments, as well as interpretation of current guidelines and optimal treatment of SAMS in different patient populations. An algorithm was developed to guide the management of patients with SAMS. In addition, the expert working group considered some of the more complex scenarios in a series of frequently asked questions and suggested answers. CONCLUSIONS: The expert working group gave recommendations for healthcare professionals on the management of SAMS but highlighted the importance of tailoring the treatment approach to each individual patient. Evidence supporting the role of nutraceuticals and complementary therapies, such as vitamin D, was lacking, however the majority of the group favoured combination therapy with ezetimibe and the addition of PCSK9 inhibitors in high-risk patients.
Authors: Emily Herrett; Elizabeth Williamson; Kieran Brack; Alexander Perkins; Andrew Thayne; Haleema Shakur-Still; Ian Roberts; Danielle Prowse; Danielle Beaumont; Zahra Jamal; Ben Goldacre; Tjeerd van Staa; Thomas M MacDonald; Jane Armitage; Michael Moore; Maurice Hoffman; Liam Smeeth Journal: Health Technol Assess Date: 2021-03 Impact factor: 4.014
Authors: Ulrich Laufs; Maciej Banach; G B John Mancini; Daniel Gaudet; LeAnne T Bloedon; Lulu Ren Sterling; Stephanie Kelly; Erik S G Stroes Journal: J Am Heart Assoc Date: 2019-04-02 Impact factor: 5.501
Authors: Emily Herrett; Elizabeth Williamson; Kieran Brack; Danielle Beaumont; Alexander Perkins; Andrew Thayne; Haleema Shakur-Still; Ian Roberts; Danielle Prowse; Ben Goldacre; Tjeerd van Staa; Thomas M MacDonald; Jane Armitage; Jon Wimborne; Paula Melrose; Jayshireen Singh; Lucy Brooks; Michael Moore; Maurice Hoffman; Liam Smeeth Journal: BMJ Date: 2021-02-24