[Approach to Patients with Statin Intolerance: Evidence-Based Review]

source extracted confidence: high 2026-04-09
#cardiovascular-diseases #ezetimibe #humans #hydroxymethylglutaryl-coa-reductase-inhibitors #hypercholesterolemia

[Approach to Patients with Statin Intolerance: Evidence-Based Review]

Almeida et al., 2020 | Acta Med Port | Systematic Review

Citation

Almeida Joana Tendais, Esteves Ana Luísa, ... Palma Isabel. [Approach to Patients with Statin Intolerance: Evidence-Based Review]. Acta Med Port. 2020-Jan-03;33(1):49-57. doi:10.20344/amp.10376

Abstract

INTRODUCTION: Statins are among the most effective drugs in lowering cholesterol levels and, consequently, in reducing cardiovascular mortality and morbidity. Although generally well tolerated, they have adverse effects that may reduce patient adherence to therapy. The objective of this evidence-based review is to summarize the evidence on the effectiveness of alternative management strategies in patients with intolerance to statins. MATERIAL AND METHODS: A literature search including clinical practice guidelines, systematic reviews and meta-analyses was conducted, in January 2017, in major international databases, and considered articles published in the last 10 years. The search was complemented with research papers published over the past three years and found in the PubMed database. The level of evidence and strength of recommendation were determined using the scale Strength of Recommendation Taxonomy - SORT. RESULTS: We included eight guidelines, six systematic reviews and one research paper. DISCUSSION: The strategies proposed by the different studies vary according to the severity of symptoms of intolerance including maintenance of the statin therapy (dose reduction, addition of a statin of equal or lower intensity or alternate days' uptake) and lipid-lowering therapy with other drugs (ezetimibe monotherapy or association with statin tolerated dose). Supplementation with coenzyme Q10 or vitamin D, in order to improve adherence to treatment with statins, is not recommended. CONCLUSION: This review highlights some alternatives to address patients' intolerance to statins; however, these are mostly based on recommendations with low to moderate evidence. Therefore, further research with randomized studies involving greater number of patients is required, in order to obtain a more robust recommendation.

Key Findings

We included eight guidelines, six systematic reviews and one research paper.

Outcomes Measured

  • Requires manual extraction

Population

Field Value
Population intolerance to statins
Sample Size See abstract
Age Range See abstract
Condition See abstract

MeSH Terms

  • Cardiovascular Diseases
  • Ezetimibe
  • Humans
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors
  • Hypercholesterolemia
  • Hypolipidemic Agents
  • Meta-Analysis as Topic
  • Practice Guidelines as Topic
  • Systematic Reviews as Topic

Evidence Classification

  • Level: Systematic Review
  • Publication Types: Journal Article, Systematic Review
  • Vertical: coq10

Provenance

Source extracted via PubMed E-utilities API on 2026-04-09