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Best Pract Res Clin Endocrinol Metab. 2014 Jun;28(3):439-52. doi: 10.1016/j.beem.2014.01.006. Epub 2014 Jan 23.

Overcoming toxicity and side-effects of lipid-lowering therapies.

Author information

  • 1University of Chicago, Department of Medicine, Chicago, IL, USA. Electronic address: michael.wilkinson@uchospitals.edu.
  • 2University of Chicago, Department of Medicine, Chicago, IL, USA. Electronic address: luke.laffin@uchospitals.edu.
  • 3University of Chicago, Department of Medicine, Chicago, IL, USA. Electronic address: mdavidso@bsd.uchicago.edu.


Lowering serum lipid levels is part of the foundation of treating and preventing clinically significant cardiovascular disease. Recently, the American Heart Association/American College of Cardiology released cholesterol guidelines which advocate for high efficacy statins rather than LDL-c goals for five patient subgroups at high risk for cardiovascular disease. Therefore, it is critical that clinicians have an approach for managing side-effects of statin therapy. Statins are associated with myopathy, transaminase elevations, and an increased risk of incident diabetes mellitus among some patients; connections between statins and other processes, such as renal and neurologic function, have also been studied with mixed results. Statin-related adverse effects might be minimized by careful assessment of patient risk factors. Strategies to continue statin therapy despite adverse effects include switching to another statin at a lower dose and titrating up, giving intermittent doses of statins, and adding non-statin agents. Non-statin lipid-lowering drugs have their own unique limitations. Management strategies and algorithms for statin-associated toxicities are available to help guide clinicians. Clinical practice should emphasize tailoring therapy to address each individual's cholesterol goals and risk of developing adverse effects on lipid-lowering drugs.

Copyright © 2014 Elsevier Ltd. All rights reserved.


atherosclerosis; cardiovascular diseases; drug toxicity; hydroxymethylglutaryl-CoA reductase inhibitors; hypercholesterolemia; lipoproteins

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