Overcoming Barriers to Statin Adherence

Arden Bui, PharmD Candidate 2021; Juwon Kwon, PharmD; Jennifer Kim, PharmD, BCPS, BCACP, CPP; Austin Lucas, PharmD


US Pharmacist. 2019;44(6):19-22. 

In This Article

Managing Statin Intolerance

Statin intolerance may occur at any time during therapy, with an incidence of 10% to 15%.[20] Myopathy can occur in 3% to 5% of patients, and severe cases (e.g., rhabdomyolysis) are less common (<1%).[6] Statin-intolerant patients with a history of MI have a 50% higher risk of recurrent MI, CVD events, and hospitalizations than patients adherent to high-intensity statins.[21]

Given the benefits of statin therapy, it is prudent to identify "true" intolerance. Placebo-controlled, randomized trials showed that most statin-attributed adverse events were not actually caused by the statin.[19] A retrospective cohort study found 92% of rechallenged patients able to tolerate statins long-term.[22]

The American College of Cardiology provides an app to guide statin intolerance evaluation and management; Table 2 summarizes prevention and management strategies.[23–28]

Rosuvastatin and pravastatin may be more tolerable, owing to hydrophilicity compared with lipophilicity with simvastatin and atorvastatin.[29] Dose reduction, alternate-day, or once-weekly administration can improve lipid concentrations, though not to the extent of daily dosing, and are well-tolerated.[21] Rosuvastatin's potency and 20-hour elimination half-life (compared with 14 hours for atorvastatin and 1–2 hours for pravastatin and simvastatin) make it appealing for these dosing methods.[29] However, CVD outcomes may decline with these methods, keeping in mind a 20% to 25% reduction in CVD mortality per 38.7 mg/dL LDL cholesterol reduction.[30] Therefore, daily dosing should be encouraged as tolerated.