Diagnosis and Management of Statin-Associated Muscle Symptoms

초록

Statin-associated muscle symptoms (SAMS) are the leading cause of statin discontinuation, potentially undermining cardiovascular protection. This review outlines the pathophysiology, risk factors, clinical features, and diagnostic challenges of SAMS, stressing the need to differentiate true intolerance from nonspecific symptoms. Diagnostic tools include dechallenge-rechallenge protocols and the SAMS-clinical index. Management involves dose adjustment, switching statins, or using non-statin agents. Recent clinical trials support the efficacy and safety of combination therapy with moderate-intensity statins and ezetimibe, especially in older patients or those with prior intolerance. A pragmatic, patient-centered approach is essential to optimize therapy, improve adherence, and minimize cardiovascular risk. ABSTRACT Statin-associated muscle symptoms (SAMS) are a common clinical challenge that often lead to poor adherence or discontinuation of statin therapy, thereby undermining its well-established cardiovascular benefits. This review explores the current understanding of the epidemiology, pathophysiology, clinical presentation, and diagnostic considerations of SAMS, with a particular focus on distinguishing true statin intolerance from nonspecific muscle complaints. We discuss evidence-based management strategies, including statin dose adjustment, rechallenge protocols, and the application of alternative lipid-lowering therapies such as ezetimibe, PCSK9 inhibitors, and bempedoic acid. Recent clinical trials support the efficacy and tolerability of combination therapy with moderate-intensity statins and ezetimibe, particularly in high-risk patients. A pragmatic, patient-centered approach is crucial for maintaining lipid-lowering therapy, minimizing adverse effects, and effectively reducing cardiovascular risk.

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