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.