Statin Intolerance

• Statin Intolerance is defined as “one or more adverse effects associated with Statin therapy, which resolves or improved with dose reduction or discontinuation.”

• Liver Injury is very rarely associated with Statins.

• Patients of Diabetes with or without ASCVD should be offered Statins because the benefit outweighs the risk.

• Primary prevention in low baseline CV risk

• Decide to initiate statin individually after careful estimation of CV risk and the adverse effect of Statin when Pharmacological therapy is ineffective.

• Treatment of Statin Intolerance

• Restructuring Statins

• Nonstatin drugs – Ezetimibe, Bempedoic acid, Pitavastatin

• Other-bile acid Sequestrants, Fibrates, Red Yeast Rice, Coenzyme Q10, Vitamin D supplements.

• There is no specific lab test, imaging technology or even tissue biopsy which is conclusive of diagnosis of Statin Intolerance.

• Long-term outcome trial of various Statin and Nonstatin regimens in patients with Statin Intolerance is still lacking.

• The definition of Statin Intolerance should also include information on risk and prognosis.