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Assessment and management of statin-associated muscle symptoms (SAMS): A clinical perspective from the National Lipid Association.

Publication ,  Journal Article
Warden, BA; Guyton, JR; Kovacs, AC; Durham, JA; Jones, LK; Dixon, DL; Jacobson, TA; Duell, PB
Published in: J Clin Lipidol
2023

Statin-associated muscle symptoms (SAMS) are the most common form of statin intolerance and are associated with increased risk of cardiovascular events that manifest from statin underutilization and discontinuation. The reported frequencies of SAMS are divergent in the literature. The writing group estimates the prevalence of SAMS, namely all muscle symptoms temporally related to statin use but without regard to causality, to be about 10% (range 5% to 25%), and the prevalence of pharmacological SAMS, specifically muscle symptoms resulting from pharmacological properties of the statin, to be about 1-2% (range 0.5% to 4%). In clinical practice, SAMS are likely to result from a combination of pharmacological and nonpharmacological effects, however this does not make the symptoms any less clinically relevant. Regardless of the etiology, SAMS need to be addressed in accordance with patients' preferences and experiences. This clinical perspective reviews the epidemiology and underlying pathophysiology of SAMS, and the cardiovascular consequences resulting from statin discontinuation. We present patient-centered clinical and communication strategies to mitigate SAMS and improve medication adherence and outcomes among statin users. Treatment strategies include 1) optimizing lifestyle interventions, 2) modulating risk factors that may contribute to muscle symptoms, 3) optimizing statin tolerability by dose reduction, decreased dosing frequency, or use of an alternate statin with more favorable pharmacokinetic properties, and 4) use of non-statins, emphasizing those with evidence for atherosclerotic risk reduction, either in combination with or in place of statin therapy depending on the patient's circumstances. The focus of this clinical perspective is sustainable lipoprotein goal achievement, which is important for cardiovascular risk reduction.

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Published In

J Clin Lipidol

DOI

ISSN

1933-2874

Publication Date

2023

Volume

17

Issue

1

Start / End Page

19 / 39

Location

United States

Related Subject Headings

  • Risk Factors
  • Muscular Diseases
  • Muscles
  • Lipids
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors
  • Humans
  • Cardiovascular System & Hematology
  • 3205 Medical biochemistry and metabolomics
  • 3201 Cardiovascular medicine and haematology
  • 1102 Cardiorespiratory Medicine and Haematology
 

Citation

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Warden, B. A., Guyton, J. R., Kovacs, A. C., Durham, J. A., Jones, L. K., Dixon, D. L., … Duell, P. B. (2023). Assessment and management of statin-associated muscle symptoms (SAMS): A clinical perspective from the National Lipid Association. J Clin Lipidol, 17(1), 19–39. https://doi.org/10.1016/j.jacl.2022.09.001
Warden, Bruce A., John R. Guyton, Adrienne C. Kovacs, Jessica A. Durham, Laney K. Jones, Dave L. Dixon, Terry A. Jacobson, and P Barton Duell. “Assessment and management of statin-associated muscle symptoms (SAMS): A clinical perspective from the National Lipid Association.J Clin Lipidol 17, no. 1 (2023): 19–39. https://doi.org/10.1016/j.jacl.2022.09.001.
Warden BA, Guyton JR, Kovacs AC, Durham JA, Jones LK, Dixon DL, et al. Assessment and management of statin-associated muscle symptoms (SAMS): A clinical perspective from the National Lipid Association. J Clin Lipidol. 2023;17(1):19–39.
Warden, Bruce A., et al. “Assessment and management of statin-associated muscle symptoms (SAMS): A clinical perspective from the National Lipid Association.J Clin Lipidol, vol. 17, no. 1, 2023, pp. 19–39. Pubmed, doi:10.1016/j.jacl.2022.09.001.
Warden BA, Guyton JR, Kovacs AC, Durham JA, Jones LK, Dixon DL, Jacobson TA, Duell PB. Assessment and management of statin-associated muscle symptoms (SAMS): A clinical perspective from the National Lipid Association. J Clin Lipidol. 2023;17(1):19–39.
Journal cover image

Published In

J Clin Lipidol

DOI

ISSN

1933-2874

Publication Date

2023

Volume

17

Issue

1

Start / End Page

19 / 39

Location

United States

Related Subject Headings

  • Risk Factors
  • Muscular Diseases
  • Muscles
  • Lipids
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors
  • Humans
  • Cardiovascular System & Hematology
  • 3205 Medical biochemistry and metabolomics
  • 3201 Cardiovascular medicine and haematology
  • 1102 Cardiorespiratory Medicine and Haematology