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Canadian Journal of Cardiology

Diagnosis, Prevention, and Management of Statin Adverse Effects and Intolerance: Canadian Working Group Consensus Update

Published:October 28, 2013DOI:https://doi.org/10.1016/j.cjca.2013.09.023

      Abstract

      The Proceedings of a Canadian Working Group Consensus Conference, first published in 2011, provided a summary of statin-associated adverse effects and intolerance and management suggestions. In this update, new clinical studies identified since then that provide further insight into effects on muscle, cognition, cataracts, diabetes, kidney disease, and cancer are discussed. Of these, the arenas of greatest controversy pertain to purported effects on cognition and the emergence of diabetes during long-term therapy. Regarding cognition, the available evidence is not strongly supportive of a major adverse effect of statins. In contrast, the linkage between statin therapy and incident diabetes is more firm. However, this risk is more strongly associated with traditional risk factors for new-onset diabetes than with statin itself and any possible negative effect of new-onset diabetes during statin treatment is far outweighed by the cardiovascular risk reduction benefits. Additional studies are also discussed, which support the principle that systematic statin rechallenge, and lower or intermittent statin dosing strategies are the main methods for dealing with suspected statin intolerance at this time.

      Résumé

      La conférence de consensus Proceedings of a Canadian Working Group Consensus Conference, publiée pour la première fois en 2011, a fourni un résumé sur les effets indésirables et l'intolérance associés aux statines et des suggestions de prise en charge. Dans cette mise à jour, nous discutons des autres perspectives sur les effets sur les muscles, la cognition, les cataractes, le diabète, la maladie rénale et le cancer que les nouvelles études cliniques ont depuis offert. Parmi ceux-ci, les aspects les plus controversés concernent les effets prétendus sur la cognition et l'apparition du diabète durant le traitement à long terme. En ce qui concerne la cognition, les données scientifiques disponibles n'appuient pas de manière ferme un effet indésirable majeur des statines. Par opposition, le lien entre le traitement par statines et l'incidence du diabète est plus solide. Cependant, ce risque est plus étroitement associé aux facteurs de risque traditionnels d'un diabète d'apparition récente que les statines en soi, et tout effet négatif possible d'un diabète d'apparition récente durant le traitement par statines est de loin compensé par les effets positifs de la réduction du risque de maladie cardiovasculaire. On discute également d'études additionnelles, qui soutiennent le principe que la reprise systématique des statines, et des stratégies de posologies plus faibles ou intermittentes des statines sont pour le moment les principales méthodes pour composer avec la suspicion d'intolérance liée aux statines.
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