Advertisement
Perspectives

Statin intolerance in people with diabetes: a clinical approach

Alicia Jenkins, David O’Neal

Figures

© blyjak/istockphoto.com
© blyjak/istockphoto.com

Abstract

Diagnosing statin intolerance is challenging because of a lack of specific diagnostic tests and high background rates of muscle and liver abnormalities. Ideally the patient’s abnormalities should be reassessed after statin withdrawal and rechallenge, and alternative diagnoses should be explored. Well-proven management options for statin intolerance are changing to an alternative statin, low-dose statin therapy and trialling other LDL-cholesterol lowering drugs.

Key Points

  • HMG-CoA reductase inhibitors (statins) are of proven benefit for the primary and secondary prevention of coronary artery disease in people with diabetes.
  • Improper management of presumed statin intolerance can lead to missing an alternative diagnosis and people not gaining statin-related cardiovascular risk reduction benefit.
  • The diagnosis of statin intolerance is hampered by the lack of specific tests and high background rates of muscle symptoms and abnormal liver function tests.
  • Ideally the diagnosis should be confirmed after statin withdrawal and rechallenge with the same or another statin following resolution of abnormalities and consideration of alternative diagnoses.
  • Many people who have experienced statin intolerance are able to tolerate an alternative statin, low-dose statin therapy or other LDL-cholesterol lowering drugs.

Figures

© blyjak/istockphoto.com
© blyjak/istockphoto.com