Statin-associated myopathy: clinical guideline of Slovak Atherosclerosis Association and Czech Society for Atherosclerosis

Authors: Daniel Pella;  Anna Gvozdjáková;  Ján Lietava;  Jana Tisoňová;  Katarína Rašlová;  Branislav Vohnout (za Slovenskou Asociaci Aterosklerózy);  Michal Vrablík;  Vladimír Bláha;  Renata Cífková;  Richard Češka;  Tomáš Freiberger;  Pavel Kraml;  Jan Piťha;  Hana Rosolová;  Vladimír Soška;  Tomáš Štulc;  Hana Vaverková;  Zuzana Urbanová (za Českou Společnost Pro Aterosklerózu)
Published in: AtheroRev 2016; 1(1): 7-13
Category: Guidelines

*(za Slovenskou asociaci aterosklerózy)
**(za Českou společnost pro aterosklerózu)


Side effects of lipid lowering drugs have gained much attention. In general, statin intolerance is defined as muscle or other adverse effects (or laboratory abnormalities) associated with statin treatment, which lead to its discontinuation or make the dose titration (and, thus, attaining LDL-cholesterol goals) impossible. The frequency of statin intolerance varies between 1% and 20% in different groups reported. The most important category is statin associated myopathy (SAM). As there is no laboratory marker of SAM with sufficient sensitivity and specificity, it is recommended to use a score system to assess the probability of SAM based on symptoms´ characteristics. There are many risk factors of the development of SAM (including drug interactions) that should be evaluated (and eliminated, if possible) before the initiation of statin treatment. From the treatment point of view, it is necessary to mention most patients with SAM are able to tolerate another statin/alternative dosing of a statin. In case of absolute intolerance (e.g. intolerance of at least 2 or 3 different statins) non-statin lipid lowering drugs should be considered. Novel therapeutic options (PCSK9 inhibitors) seem to be very promising in this respect.

Key words:
alternative therapy – lipid lowering drugs – score system – side effects – statins – statin associated myopathy – statin intolerance


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Angiology Diabetology Internal medicine Cardiology General practitioner for adults
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