Statin intolerance: an updated, narrative review mainly focusing on muscle adverse effects

Jian Jun Li, Hui Hui Liu, Na Qiong Wu, Khung Keong Yeo, Kathryn Tan, Junya Ako, Rungroj Krittayaphong, Ru San Tan, Philip E. Aylward, Sang Hong Baek, Jamshed Dalal, Alan Yean Yip Fong, Yi Heng Li, Richard C. O’Brien, Tien Siang Eric Lim, Si Ya Natalie Koh, Daniel J. Scherer, Hayato Tada, Vernon Kang, Julie ButtersStephen J. Nicholls

Research output: Contribution to journalReview articlepeer-review

11 Citations (Scopus)


Introduction: Statins have been established as the standard of care for dyslipidemia and preventing cardiovascular diseases while posing few safety concerns. However, misconceptions about statin intolerance lead to their underuse, indicating a need to improve the understanding of the safety of this treatment. Areas covered: We searched PubMed and reviewed literatures related to statin intolerance published between February 2015 and February 2020. Important large-scale or landmark studies published before 2015 were also cited as key evidence. Expert opinion: Optimal lowering of low-density lipoprotein cholesterol with statins substantially reduces the risk of cardiovascular events. Muscle adverse events (AEs) were the most frequently reported AEs by statin users in clinical practice, but they usually occurred at a similar rate with statins and placebo in randomized controlled trials and had a spurious causal relationship with statin treatment. We proposed a rigorous definition for identifying true statin intolerance and present the criteria for defining different forms of muscle AEs and an algorithm for their management. True statin intolerance is uncommon, and every effort should be made to exclude false statin intolerance and ensure optimal use of statins. For the management of statin intolerance, statin-based approaches should be prioritized over non-statin approaches.

Original languageEnglish
Pages (from-to)837-851
Number of pages15
JournalExpert Opinion on Drug Metabolism and Toxicology
Issue number9
Publication statusPublished - 1 Sept 2020


  • Cardiovascular disease
  • definition
  • dyslipidemia
  • management
  • mechanism
  • muscle toxicity
  • nonstatin
  • Statin
  • statin intolerance


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