Statin-Associated Side Effects

J Am Coll Cardiol. 2016 May 24;67(20):2395-2410. doi: 10.1016/j.jacc.2016.02.071.


Hydroxy-methyl-glutaryl-coenzyme A (HMG-CoA) reductase inhibitors or statins are well tolerated, but associated with various statin-associated symptoms (SAS), including statin-associated muscle symptoms (SAMS), diabetes mellitus (DM), and central nervous system complaints. These are "statin-associated symptoms" because they are rare in clinical trials, making their causative relationship to statins unclear. SAS are, nevertheless, important because they prompt dose reduction or discontinuation of these life-saving mediations. SAMS is the most frequent SAS, and mild myalgia may affect 5% to 10% of statin users. Clinically important muscle symptoms, including rhabdomyolysis and statin-induced necrotizing autoimmune myopathy (SINAM), are rare. Antibodies against HMG-CoA reductase apparently provoke SINAM. Good evidence links statins to DM, but evidence linking statins to other SAS is largely anecdotal. Management of SAS requires making the possible diagnosis, altering or discontinuing the statin treatment, and using alternative lipid-lowering therapy.

Keywords: interstitial lung disease; myopathy; rhabdomyolysis; skeletal muscle.

Publication types

  • Review

MeSH terms

  • Acute Kidney Injury / chemically induced
  • Antibodies / blood
  • Autoimmune Diseases / chemically induced
  • Brain / drug effects
  • Cognition Disorders / etiology
  • Depression / chemically induced
  • Diabetes Mellitus / chemically induced
  • Humans
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors / adverse effects*
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors / immunology
  • Hyperlipidemias / complications
  • Hyperlipidemias / drug therapy
  • Liver Function Tests
  • Lung Diseases, Interstitial / chemically induced
  • Muscular Diseases / chemically induced
  • Myalgia / chemically induced
  • Necrosis / chemically induced
  • Rhabdomyolysis / chemically induced
  • Risk Factors
  • Rupture / chemically induced
  • Sleep Wake Disorders / chemically induced
  • Stroke / chemically induced
  • Tendon Injuries / chemically induced
  • Testosterone / blood


  • Antibodies
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors
  • Testosterone