•If rhabdomyolysis (SRM5) is suspected, immediately stop statins, urgently refer Participants who demonstrated statin intolerance only on atorvastatin were randomized to two alternative treatments to lower LDL cholesterol—evolocumab or ezetimibe. Results indicate that, on average, patients showed a 52.8% reduction on evolocumab compared with 16.7% reduction with ezetimibe and there was little difference in muscle-related adverse effects. Although the role of high-intensity statin therapy after ACS is indisputable, statin intolerance is a major issue that affects up to 20% of patients (based on observational studies). Page 2 of 3 entering the pathophysiology of myalgias it is useful to establish diagnostic criteria of the various conditions known as statin-related myopathy. On J Cardio Res & Rep. 3(2): 2019. However, it highlights the muscle-related adverse effects that can occur with statins. DOI: 10.33552/OJCR.2019.03.000559. In a study of 11124 The main results of this study relate to the lipid-lowering effects of two alternative non-statin medications. Intolerance to alternative statin dosing was seen in 24 of the 87 (28%) patients. In most cases, rechal-lenge with a statin after a brief period of drug discontinuation (“drug holiday”) can be successful. OJCR. MS.ID.000559. statin intolerance. Intensify lifestyle modifications and consider alternative lipid lowering regimens. Henrique Andrade Rodrigues da Fonseca. If intolerance is associated with all statins-even at the lowest dose-non-statin drugs and certain nutraceuticals can be considered. Patients, together with their healthcare providers, must weigh the risk of drug discontinuation versus the benefits before making permanent decisions about the management of statin intolerance. Conclusion: In conclusion, prior to initiating PCSK9 inhibition in patients with daily statin intolerance, a trial of alternative statin dosing should be attempted. In ODYSSEY ALTERNATIVE, comparing alirocumab with ezetimibe in patients at moderate to high ASCVD risk with confirmed statin intolerance (i.e. Before considering the use of a second-line alternative drug, patients should try statin rechal-lenge, alternative regimens, doses, or types of statins. Before considering the use of a second-line alternative drug, patients should try statin rechallenge, alternative regimens, doses, or types of statins. 3 Among those with statin intolerance, proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i) may provide an alternative that allows for substantial low-density lipoprotein cholesterol (LDL-C) reduction. The success of alternative statin dosing cannot be predicted by the baseline level of LDL-cholesterol. Statin Intolerance: Physiology and Treatment Alternatives. This review focuses on the definition of statin intolerance and on the development of clinical and therapeutic strategies for its management, including emerging alternative …

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