NLA scientific statement on statin intolerance: a new definition and key considerations for ASCVD risk reduction in the statin intolerant patient

Cheeley, Mary Katherine; Saseen, Joseph J.; Agarwala, Anandita; Ravilla, Sudha; Ciffone, Nicole A.; Jacobson, Terry A.; Dixon, Dave L.; Maki, Kevin C.

doi:10.1016/j.jacl.2022.05.068

Cited by 76 publications

(71 citation statements)

References 75 publications

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“…Statin intolerance is defined as one or more adverse effects associated with statin therapy, which resolves or improves with dose reduction or discontinuation. They can be classified as a complete inability to tolerate any dose of a statin or partial intolerance, with an inability to tolerate the dose necessary to achieve the patient-specific therapeutic objective [ 135 ]. To classify a patient as having statin intolerance, a minimum of two statins should have been attempted, including at least one at the lowest approved daily dosage [ 136 ].…”

Section: Lipid Management According To Cac/ccta Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Imaging subclinical coronary atherosclerosis to guide lipid management, are we there yet?

Piña

Lorenzatti

Paula

et al. 2023

American Journal of Preventive Cardiology

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Section: Lipid Management According To Cac/ccta Resultsmentioning

confidence: 99%

“…The most frequently reported patient complaints in the clinical setting are SAMS. In most cases, they occur without CK elevation [ 135 ]. In the JUPITER trial, the incidence of myalgia in the statin- and placebo-treated groups were 16% and 15.4%, respectively [ 101 ].…”

Section: Lipid Management According To Cac/ccta Resultsmentioning

confidence: 99%

Imaging subclinical coronary atherosclerosis to guide lipid management, are we there yet?

Piña

Lorenzatti

Paula

et al. 2023

American Journal of Preventive Cardiology

View full text Add to dashboard Cite

“…Moreover, it is important to mention that we did not find any significant difference in CK levels between patients on statin and the control group which can be explained by the low incidence of CK elevation in statin-associated muscle disorders. 19…”

Section: Discussionmentioning

confidence: 99%

“…25 However, it is important to mention that the recent National Lipid Association (NLA) guidelines estimated that the complete statin therapy intolerance is less than 5%. 19 Moreover, studies showed that low adherence to statins might be the main reason for inadequate LDL control and higher cardiovascular events risk. 26,27 Moreover, it is important to mention that statin adherence affects the adherence of other cardiovascular medications including beta-blockers and angiotensin-converting enzyme inhibitors (ACEis).…”

Section: Discussionmentioning

confidence: 99%

The Significance of Statin Associated Muscle Symptoms and Its Impact on Patients Adherence and Outcomes

Al-Makhamreh

Toubasi

Obaid

et al. 2022

Journal of Cardiovascular Pharmacology

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Statin-associated muscle symptoms (SAMS) are one of the most common side effects of statins. This study aimed to explore the significance of SAMS among statin users by comparing statin users with a control group. To achieve our aims, a propensity score matching the retrospective cohort study was conducted in a single center tertiary hospital. The statin muscle symptoms were assessed using the Proposed Statin Myalgia Index Score, whereas the patient's adherence to medications was evaluated using the Morisky Medication Adherence Scale-8. We included 743 patients in our study; of them, 64.9% were on statin, whereas the rest were controls (35.1%). After propensity score matching, patients on statin had significantly higher rates of SAMS (5.0%) compared with control (1.6%) (AOR = 3.209; 95% CI: 1.020-10.091). However, there was no significant difference between statin users and controls in medications nonadherence (P-value = 0.820). Our analysis among statins users revealed that moderate-intensity (2.671; 95% CI: 1.691-3.310) and high-intensity (3.552; 95% CI: 2.190-4.129) statin therapy was significantly associated with SAMS. In addition, autoimmune diseases were significantly associated with SAMS occurrence (AOR = 32.301; 95% CI: 1.785-584.374). Also, patients on PPIs had significantly less occurrence of SAMS (AOR = 0.145; 95% CI: 0.044-0.483), whereas patients on antiepileptic drugs had significantly higher SAMS occurrence (AOR = 72.337; 95% CI: 2.649-1975.201). Regarding MACE among statin users, there was no significant difference in the 1-year or 5-year MACE rate between statin users and controls. Our study suggests that SAMS are significant among statin users and must be addressed by health care providers to ensure that patients are still adherent to their medications and hence protected against cardiac events.

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“…Az ezetimib tekintetében a bizonyítottságot -az ajánlás I. osztályú erősségével szemben -a grémium csak B-szintűnek minősítette, annak ellenére, hogy az ezetimib vs. placebo véletlen besorolásos vizsgálatok metaanalízisének egyértelmű pozitív eredménye (3) alapján az A-minősítés is indokolt lehetett volna. (Az amerikai National Lipid Association három nagy ezetimibes vizsgálatot is elfogad bizonyító erejűnek, az IMPROVE-IT-t, SHARP-ot és az EW-TOPIA 75-öt [4]). Ha a "maximálisan tolerálható" statinnal és ezetimibbel az igen nagy kockázat igényelte cél nem érhető el, a proprotein-konvertáz szubtilizin/kexin-9 típusának (PCSK9) gátlása is javasolt, szekunder prevencióban (I.A-ajánlás) vagy familiáris hypercholesterinaemia esetén (I.C-ajánlás).…”

Section: Gyógyszeres Lipidkezelésunclassified

Újabb evidenciák és ajánlások a kardiovaszkuláris kockázat lipidológiai, diabetológiai és egyéb endokrin-anyagcsere módon történő csökkentése vonatkozásában

Bajnok¹

2022

Cardiologia Hungarica

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Az elmúlt években született nagy klinikai vizsgálatok csak erősítették és nem cáfolták, hogy annál jobb minél erélyesebben és minél korábban kezdjük az aterogén koleszterin csökkentését. Ennek ellenére a 2021-es ESC prevenciós irányelv jelentősen visszaveszi a 2019-es ESC/EAS-ajánlás progresszívitását. A HDL protektív hipotézisét viszont inkább cáfolták a friss érdemi vizsgálatok és a halolajjal nyert eredmények is ellentmondásosak. Ígéretes viszont a lipoprotein(a) – Lp(a) –, az angiopoietin-like 3 (ANGPTL3) fehérje és az apolipoprotein C-III (Apo CIII) innovatív módon történő csökkentése. Bár a nátrium-glükóz kotranszporter-2-gátlók és a glucagonlike peptid-1-agonisták a major kardio- és cerebrovaszkuláris események számát csak szerényen (10-14%-kal) mérséklik, egyéb klinikai – vesére, szívizomra, illetve zsírmájra gyakorolt – hatásaik is fontosak. Az újabb hormon-, vitamin-, vagy ásványianyag-pótlást, illetve súly- vagy húgysavszint-csökkentést célzó gyógyszeres próbálkozások sem igazoltak pozitív hatást.

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NLA scientific statement on statin intolerance: a new definition and key considerations for ASCVD risk reduction in the statin intolerant patient

Cited by 76 publications

References 75 publications

Imaging subclinical coronary atherosclerosis to guide lipid management, are we there yet?

Imaging subclinical coronary atherosclerosis to guide lipid management, are we there yet?

The Significance of Statin Associated Muscle Symptoms and Its Impact on Patients Adherence and Outcomes

Újabb evidenciák és ajánlások a kardiovaszkuláris kockázat lipidológiai, diabetológiai és egyéb endokrin-anyagcsere módon történő csökkentése vonatkozásában

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