Primary Evaluation and Management of Statin Therapy Complications

Dean A. Seehusen, MD, MPH, FAAFP; Chad A. Asplund, MD; Dawn R. Johnson, DO; Kevin Horde, A. DO


South Med J. 2006;99(3):250-254. 

In This Article

Abstract and Introduction

HMG-CoA reductase inhibitors (statins) have become one of the most commonly prescribed classes of medications in the United States. While serious adverse events are rare, less serious events are frequently seen. Published guidelines recommend initial screening labs as well as ongoing monitoring of liver enzymes during therapy. Up to 5% of patients will have some muscle complaints while taking statins. Therefore, primary care clinicians will often be faced with real or potential complications of statin therapy. There are well established risk factors for development of these complications. Being aware of a patient's risk and using the lowest effective dose minimizes the occurrence of adverse events. The great majority of these abnormalities either do not require discontinuation of therapy or require only brief interruption of therapy. Judicious and systematic use of laboratory testing will minimize needless evaluation and premature discontinuation of statin therapy.

Statins (3-hydroxy-3-methylglutaryl coenzyme-A reductase inhibitors) have become the mainstay of therapy for controlling lipid disorders. The future promises more patients will be taking these medications as goals for cholesterol therapy are dropped and new indications for statin therapy are introduced. While serious adverse events are rare with statin therapy, less serious side effects and minor laboratory abnormalities are relatively common. Most of the common issues encountered during statin therapy are either self-limited or can be easily addressed without permanently discontinuing statin therapy. A thoughtful approach to monitoring and evaluating statin side effects will allow most patients to continue to reap the benefits of this valuable class of lipid lowering agents. This review covers the two most commonly encountered clinical situations that represent potential adverse effects of statin therapy: myopathy and elevated transaminases.