This post was authored by Kim Birtcher, MS, PharmD, AACC, chair of the ACC’s LDL: Address the Risk Oversight Workgroup.

The benefits of statin therapy in reducing the morbidity and mortality associated with atherosclerotic cardiovascular disease (ASCVD) are well documented; however, statins remain underutilized for both primary and secondary prevention. Two years ago the ACC launched its LDL: Address the Risk Initiative with the goal of closing this disparity in care and improving patient outcomes by increasing awareness of the gaps in lipid management, including the importance of managing LDL-related risks.

During the first LDL: Address the Risk Think Tank in 2013, participants identified perceived statin intolerance as one of the major barriers to statin adherence and a key contributor to the underutilization of statin therapy. Although muscle symptoms may occur while on statin therapy, true statin intolerance is not common. Therefore, helping clinicians determine whether a patient is experiencing symptoms related to statin therapy or another cause was determined to be a role the ACC could fill.

In order to keep all appropriate patients on statin therapy to reduce the risk of ASCVD, it is important for clinicians to partner with their patients to gain a thorough symptom history. For example, the patient's muscle symptoms may be caused by recent exercise, a treatable medical condition (e.g., hypothyroidism, vitamin D deficiency), or a drug interaction that increases the exposure to the current statin dose. Some patients (e.g, females, Asians, elderly) may be at more risk for statin-related muscle symptoms; however, these patients may be able to take a lower dose of statin or an alternative statin without problems. The clinician must consider the characteristics of the individual statins (e.g., lipophilicity, half-life, metabolism, potential for drug interactions) when selecting the subsequent statins and doses. A patient who has had muscle symptoms with a statin or several statins may be able to tolerate a lower daily dose of statin, a different statin, or non-daily use of the longer acting statins. Through the clinician-patient partnership, it may be necessary to treat and manage a patient reporting muscle symptoms with cycles of statin discontinuation and rechallenge to identify a tolerated statin and dose.

The ACC developed its Statin Intolerance App to facilitate and add structure to these discussions in a manner that is quick, easy and can be used at the bedside or in the clinic. Derived from the ACC/AHA’s 2013 Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults and the prescribing information for each statin, the App is designed to guide the process of evaluating, treating and managing a patient who reports muscle symptoms on current statin therapy. It includes questions to help evaluate if muscle symptoms could be due to a patient's current statin therapy; step-by-step guidance to treat and manage statin-related muscle symptoms; and a drug comparison tool to review characteristics and secondary drug interactions within and across statins. The App does not provide information or guidance about non-statin lipid lowering therapy.

The ACC will continue to play a key part in providing the best LDL information and tools for clinicians and patients. The next LDL: Address the Risk Think Tank is already scheduled for this fall. Those interested in learning more about LDL: Address the Risk can read more here. Also check out a new Meeting on Demand Program, Lipid Management Today: Unanswered Questions and Unquestioned Answers here.

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