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April 19, 2016

PCSK9 Inhibitors for Statin Intolerance?

Author Affiliations
  • 1Division of Cardiology, San Francisco General Hospital, San Francisco, California
  • 2Department of Medicine, University of California-San Francisco
  • 3Division of Cardiology, New York University School of Medicine, New York, New York
JAMA. 2016;315(15):1571-1572. doi:10.1001/jama.2016.3670

Statin intolerance is a common problem most clinicians encounter when treating patients taking these drugs. Balancing the symptoms of muscle aches in a patient in need of cholesterol-lowering medication with the clinical trial–proven benefits of statins for reducing cardiovascular events in a broad spectrum of patients can be a difficult clinical challenge.

Muscle-related adverse effects from statins are highly mutable. Considerable evidence suggests that nonpharmacologic mechanisms account for most muscle-related statin intolerance. The prevalence of statin-associated muscle symptoms ranges from 7% to 29% in registries and observational studies.1 The incidence of muscle symptoms is similar among statin-treated and placebo-treated patients across 26 long-term trials involving 170 000 patients.2 In a large retrospective cohort study, 6579 of 11 124 patients who discontinued a statin due to adverse effects were rechallenged, with 92% success in restoring therapy, although not necessarily with the same statin or dose.3 In an international survey, the incidence of intolerable statin-related adverse effects ranged from 2% in Japan, Spain, Italy, and Sweden to 10% to 12% in Canada, the United Kingdom, and the United States.4 These substantial differences are likely to be modulated by cultural factors and patient perception.