Many patients come to the pharmacy and tell me that they cannot tolerate Statins (Atorvastatin, Rosuvastatin, Simvastatin, etc.). I tell then that using Statins is extremely important to preventing heart disease, heart attacks, and premature death. Statins as a group of heart medications are responsible for preventing premature death in thousands upon thousands of individuals since 1987. 

Here are the latest guidelines for dealing with Statin Intolerance. The guidelines provide the following recommendations:

1. Non-Severe Muscle Adverse Effects (most common): When patients experience non-severe muscle adverse effects with a specific statin regimen, the guidelines suggest the following:
   • Prefer the use of any statin intensity over non-statin lipid therapy.
   • This can involve continuing with the same statin, switching to a different statin, adjusting the statin dose, or considering alternate daily dosing. The choice should be made through shared decision-making between the patient and the healthcare provider.
2. Primary Prevention in Patients Unable to Tolerate Statin (extremely rare): For patients who cannot tolerate any statin and are undergoing primary prevention, the guidelines recommend against the use of non-statin pharmacologic therapies. In this case, non-pharmacologic interventions and lifestyle modifications should be emphasized.
3. Secondary Prevention in Patients Unable to Tolerate Statin(patients who have already had a previous heart attack): When patients are unable to tolerate any statin and are undergoing secondary prevention, the guidelines advise considering the following options:
   • A discussion about the use of ezetimibe, fibrates, or PCSK9 inhibitors. These can be explored as alternative pharmacologic therapies.
   • Icosapent should be considered only after other options have been thoroughly evaluated. It’s important to note that the use of icosapent should be approached cautiously due to its potential adverse events, such as atrial fibrillation and bleeding.

These guidelines aim to provide healthcare providers with a structured approach for managing patients who experience statin intolerance, ensuring that individualized decisions are made while considering the patient’s specific circumstances and risk factors.

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