Statin-associated Muscle Symptoms: Impact on Statin Therapy—European Atherosclerosis Society Consensus Panel Statement on Assessment, Aetiology and Management

Erik S. Stroes; Paul D. Thompson; Alberto Corsini; Georgirene D. Vladutiu; Frederick J. Raal; Kausik K. Ray; Michael Roden; Evan Stein; Lale Tokgözoğlu; Børge G. Nordestgaard; Eric Bruckert; Guy De Backer; Ronald M. Krauss; Ulrich Laufs; Raul D. Santos; Robert A. Hegele; G. Kees Hovingh; Lawrence A. Leiter; Francois Mach; Winfried März; Connie B. Newman; Olov Wiklund; Terry A. Jacobson; Alberico L. Catapano; M. John Chapman; Henry N. Ginsberg


Eur Heart J. 2015;36(17):1012-1022. 

In This Article


Lowering LDL-C with statin therapy reduces CVD risk by up to 40% in a wide range of patients. Given that the main reason for statin non-adherence/discontinuation relates to the onset of (perceived) side effects, it follows that the high prevalence of SAMS reported from observational studies is likely to adversely affect the CVD benefits of statins.[119] Strategies to prevent the loss of effective statin therapy because of SAMS are still lacking. In the absence of a gold standard definition, this EAS Consensus Panel proposes to base the probability of SAMS being caused by statins on the nature of symptoms and their temporal relationship with statin initiation, statin discontinuation (or dechallenge), and repetitive re-challenge (Figure 2). Optimal therapy should combine a maximally tolerated, or even non-daily statin dose, together with non-statin-based lipid-lowering therapies in order to achieve LDL-C targets.

This Consensus Panel also highlights the need for further research into the pathophysiology of SAMS. Accumulating preclinical data show that statins decrease mitochondrial function, and alter muscle protein degradation, providing a possible pathophysiological link between statins and muscle symptoms. Studies in the clinical setting are a priority to further understanding of these mechanisms, and may offer therapeutic potential. In the absence of therapies to prevent these symptoms, this Consensus Panel recommends that the response of patients with SAMS to three or more statins should be considered for referral to specialized settings. By recognizing SAMS and adhering to a structured work-up, the Panel anticipates that individuals with clinically relevant SAMS will be offered alternative and/or novel therapeutic regimens that can satisfactorily address their CVD risk.