Camelia C Diaconu1,2, Roua A Iorga1, Florentina Furtunescu2, Niki Katsiki3, Anca P Stoian2, Manfredi Rizzo2,4. 1. Clinical Emergency Hospital of Bucharest. 2. University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania. 3. Division of Endocrinology and Metabolism, First Department of Internal Medicine, Diabetes Center, AHEPA University Hospital, Thessaloniki, Greece. 4. Department of Health Promotion Sciences Maternal and Infantile Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy.
Abstract
PURPOSE OF REVIEW: Hypercholesterolemia is a major risk factor for cardiovascular diseases. Administration of statins represents the cornerstone of the prevention and treatment of cardiovascular disease, with demonstrated long-term safety and efficacy. This review aims to revisit statin intolerance mechanisms, as well as to discuss new data and therapeutic options. RECENT FINDINGS: Although statins are well tolerated, myopathy and other adverse effects are a challenging problem, being the main reason for poor adherence to treatment and failure in lowering cardiovascular risk. Statin intolerance is the subject of ongoing research, as these drugs are widely used. There are alternative options of treatment if statin intolerance emerges, that is, lowering the dose, intermittent dosages, and/or combining a statin with other drugs, such as ezetimibe, proprotein convertase subtilisin-kexin type 9 inhibitors, bempedoic acid, angiopoietin-like 3 protein inhibitors, and nutraceuticals. If even the lowest statin dose cannot be tolerated, a nonstatin regimen is recommended to reduce LDL cholesterol levels. SUMMARY: Treatment options in statin intolerance include combinations of a lower dose of statin with other lipid-lowering regimens or only nonstatin drugs in the presence of complete intolerance. New hypolipidemic therapies that address gene editing are emerging, and may prove useful in the future.
PURPOSE OF REVIEW: Hypercholesterolemia is a major risk factor for cardiovascular diseases. Administration of statins represents the cornerstone of the prevention and treatment of cardiovascular disease, with demonstrated long-term safety and efficacy. This review aims to revisit statin intolerance mechanisms, as well as to discuss new data and therapeutic options. RECENT FINDINGS: Although statins are well tolerated, myopathy and other adverse effects are a challenging problem, being the main reason for poor adherence to treatment and failure in lowering cardiovascular risk. Statin intolerance is the subject of ongoing research, as these drugs are widely used. There are alternative options of treatment if statin intolerance emerges, that is, lowering the dose, intermittent dosages, and/or combining a statin with other drugs, such as ezetimibe, proprotein convertase subtilisin-kexin type 9 inhibitors, bempedoic acid, angiopoietin-like 3 protein inhibitors, and nutraceuticals. If even the lowest statin dose cannot be tolerated, a nonstatin regimen is recommended to reduce LDL cholesterol levels. SUMMARY: Treatment options in statin intolerance include combinations of a lower dose of statin with other lipid-lowering regimens or only nonstatin drugs in the presence of complete intolerance. New hypolipidemic therapies that address gene editing are emerging, and may prove useful in the future.
Authors: Filip M Szymański; Agnieszka Mickiewicz; Grzegorz Dzida; Iwona Gorczyca-Głowacka; Dariusz Kozłowski; Krystyna Widecka; Zbigniew Krasiński; Adam Kobayashi; Dagmara Hering; Katarzyna Mizia-Stec; Jarosław D Kasprzak; Tomasz Zubilewicz; Krzysztof Narkiewicz; Marek Koziński; Anna E Płatek; Anna Ryś-Czaporowska; Beata Chełstowska; Stefan Grajek; Marcin Wełnicki; Artur Mamcarz; Marcin Barylski; Beata Wożakowska-Kapłon; Miłosz J Jaguszewski; Marcin Gruchała; Krzysztof J Filipiak Journal: Cardiol J Date: 2021-11-23 Impact factor: 2.737
Authors: Jamie A Browning; Chi Chun Steve Tsang; Xiaobei Dong; Jim Y Wan; Marie A Chisholm-Burns; Christopher K Finch; Jack W Tsao; Colin Liu; Junling Wang Journal: BMC Health Serv Res Date: 2022-02-07 Impact factor: 2.655