| Abstract [eng] |
Introduction. Statin intolerance is a complex and clinically significant problem that limits effective dyslipidemia management and the achievement of low-density lipoprotein cholesterol (LDL-C) target levels, particularly in patients at high cardiovascular risk. Despite the well-established benefits of statins, their use in real-world clinical practice is often discontinued due to subjective or objective adverse effects. Aim of the study. To systematically evaluate the definition, pathophysiological mechanisms, clinical significance, and treatment optimization strategies of statin intolerance, with emphasis on evidence-based clinical decision-making. Methods. A narrative literature review was conducted using the PubMed database. Randomized controlled trials (RCTs), meta-analyses, systematic reviews, and international guidelines published within the last 10 years were included. Results. Evidence indicates that true statin intolerance is less common than previously assumed, and a substantial proportion of symptoms may be attributed to the nocebo effect. The pathophysiology involves mitochondrial dysfunction, metabolic and genetic factors, as well as drug interactions. In most cases, complete statin discontinuation is not warranted, as the majority of patients are able to tolerate modified statin regimens. Treatment optimization includes dose reduction, statin switching, alternative dosing strategies, and combination therapy. Novel therapies, such as PCSK9 inhibitors, inclisiran, and bempedoic acid, significantly expand treatment options. Conclusions. The management of statin intolerance should be based on an individualized, evidence-based approach aimed at maintaining optimal lipid-lowering efficacy while minimizing cardiovascular risk. |
