Volume 4 Issue 3 - 2010
This issue of Clinical Focus is concerned with statin intolerance, a problem commonly encountered in primary care. Management of elevated cholesterol in individuals with established cardiovascular disease, diabetes or high cardiovascular risk has become a routine component of clinical care in both primary care and hospital settings, and has made a significant contribution to the decline in coronary heart disease over the last twenty years. Fortunately, in the considerable majority of cases, lipid goals can be achieved easily through the use of a statin.
The preceding article discusses the frequency of statin intolerance, its main causes and the mechanisms which may underlie statin induced side-effects. In this section, an approach to the management of the statin intolerant patient will be discussed. (Figure 1)
The use of statins to effectively and safely lower cholesterol has revolutionised the treatment and prevention of atherosclerotic vascular disease. Statin treatment has now become a mainstay of the management of patients with diabetes or any form of vascular disease, and in addition is recommended in UK guidelines for otherwise healthy individuals with a ten year risk of cardiovascular disease of 20% or greater. Statin treatment brings very considerable clinical benfits, and in general is well tolerated. However, as with all drug classes, clinically significant side effects may occur and may lead to cessation of treatment, either by the patient or by the clinician. This article will describe the main statin side effects, including their aetiology (where known) and frequency, and will discuss how the risk of statin side effects can be minimised. In the following article, the management of the statin intolerant patients will be discussed.