Journal of Lipid and Atherosclerosis (지질동맥경화학회지)

The Korean Society of Lipid and Atherosclerosis (한국지질동맥경화학회)
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Statin Intolerance: an Overview of the Current Status and Possible Treatment Options

  • Suh, Sunghwan (Division of Endocrinology, Dong-A University College of Medicine) ;
  • Jung, Chang Hee (Division of Endocrinology and Metabolism, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Hong, Soon-Jun (Division of Cardiology, Korea University College of Medicine) ;
  • Kim, Jung-Sun (Division of Cardiology, Yonsei University College of Medicine) ;
  • Choi, Sung Hee (Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine)
  • Received : 2018.05.29
  • Accepted : 2018.11.06
  • Published : 2018.12.31
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Abstract

Lowering serum low-density lipoprotein cholesterol (LDL-C) is the mainstay for reduction of risk of cardiovascular disease (CVD), the second most common cause of death in Korea. The 2015 Korean guidelines for management of dyslipidemia strongly recommend the use of statins in patients at risk of CVD. Statin therapy, which is the gold standard for CVD, reduces LDL-C level by 40% to 60% and is generally well tolerated. However, many patients are intolerant to statins and discontinue therapy or become nonadherent to therapy because of actual/perceived side effects. The most common of these side effects is the statin-associated muscle symptom (SAMS). Discontinuation and repetitive re-challenge with statins can help identify SAMS. If serum creatinine kinase level is more than 10 times the upper limit of normal, statin therapy must be stopped immediately, and the physician should identify possible causes including rhabdomyolysis and treat appropriately. In other patients, it might help to switch to a less potent statin or to use statins at intermittent non-daily dosing. To achieve target LDL-C level, non-statin lipid-lowering therapies such as dietary modifications, ezetimibe, and bile acid sequestrants may be added. Several new drugs have recently been approved for lowering LDL-C level. Alirocumab and evolocumab are monoclonal antibodies that inhibit proprotein convertase subtilisin/kexin type 9, and both drugs cause large reductions in LDL-C, similar to statins. Lomitapide and mipomersen are orphan drugs used as adjuncts to other lipid-lowering therapies in patients with homozygous familial hypercholesterolemia.

Keywords

Acknowledgement

Supported by : Sanofi

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