Overcoming toxicity and side-effects of lipid-lowering therapies

Best Pract Res Clin Endocrinol Metab. 2014 Jun;28(3):439-52. doi: 10.1016/j.beem.2014.01.006. Epub 2014 Jan 23.


Lowering serum lipid levels is part of the foundation of treating and preventing clinically significant cardiovascular disease. Recently, the American Heart Association/American College of Cardiology released cholesterol guidelines which advocate for high efficacy statins rather than LDL-c goals for five patient subgroups at high risk for cardiovascular disease. Therefore, it is critical that clinicians have an approach for managing side-effects of statin therapy. Statins are associated with myopathy, transaminase elevations, and an increased risk of incident diabetes mellitus among some patients; connections between statins and other processes, such as renal and neurologic function, have also been studied with mixed results. Statin-related adverse effects might be minimized by careful assessment of patient risk factors. Strategies to continue statin therapy despite adverse effects include switching to another statin at a lower dose and titrating up, giving intermittent doses of statins, and adding non-statin agents. Non-statin lipid-lowering drugs have their own unique limitations. Management strategies and algorithms for statin-associated toxicities are available to help guide clinicians. Clinical practice should emphasize tailoring therapy to address each individual's cholesterol goals and risk of developing adverse effects on lipid-lowering drugs.

Keywords: atherosclerosis; cardiovascular diseases; drug toxicity; hydroxymethylglutaryl-CoA reductase inhibitors; hypercholesterolemia; lipoproteins.

Publication types

  • Review

MeSH terms

  • Chemical and Drug Induced Liver Injury / therapy
  • Dose-Response Relationship, Drug
  • Drug-Related Side Effects and Adverse Reactions / complications
  • Drug-Related Side Effects and Adverse Reactions / therapy*
  • Humans
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors / administration & dosage
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors / adverse effects
  • Hypolipidemic Agents / administration & dosage
  • Hypolipidemic Agents / adverse effects*
  • Kidney Diseases / chemically induced
  • Kidney Diseases / therapy
  • Muscular Diseases / chemically induced
  • Muscular Diseases / therapy
  • Nervous System Diseases / chemically induced
  • Nervous System Diseases / therapy
  • Risk Factors


  • Hydroxymethylglutaryl-CoA Reductase Inhibitors
  • Hypolipidemic Agents