NLA scientific statement on statin intolerance: a new definition and key considerations for ASCVD risk reduction in the statin intolerant patient
Open accessAbstract
Although statins are generally well tolerated, statin intolerance is reported in 5-30% of patients and contributes to reduced statin adherence and persistence, as well as higher risk for adverse cardiovascular outcomes. This Scientific Statement from the National Lipid Association was developed to provide an updated definition of statin intolerance and to inform clinicians and researchers about its identification and management. Statin intolerance is defined as one or more adverse effects associated with statin therapy which resolves or improves with dose reduction or discontinuation and can be classified as a complete inability to tolerate any dose of a statin or partial intolerance with inability to tolerate the dose necessary to achieve the patient-specific therapeutic objective. To classify a patient as having statin intolerance, a minimum of two statins should have been attempted, including at least one at the lowest approved daily dosage. This Statement acknowledges the importance of identifying modifiable risk factors for statin intolerance and recognizes the possibility of a "nocebo" effect (patient expectation of harm resulting in perceived side effects). To identify a tolerable statin regimen it is recommended that clinicians consider using several different strategies (e.g., different statin, dose, and/or dosing frequency). Non-statin therapy may be required for patients who cannot reach therapeutic objectives with lifestyle and maximal tolerated statin therapy. If…
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Statin therapy is a hallmark approach to cardiovascular prevention and treatment; however, a subset of individuals experience partial or complete intolerance to statin therapy.
“Statin therapy is a hallmark approach to cardiovascular prevention and treatment; however, a subset of individuals experience partial (inability to tolerate sufficient dosage necessary to achieve therapeutic objectives due to adverse effects) or complete (inability to tolerate any dose) intolerance to statin therapy (133).”
From 10. Cardiovascular Disease and Risk Management: Standards of Care in Diabetes—2025 (2025) · cites this paper as [133]
A subset of individuals experience partial or complete intolerance to statin therapy.
“Statin therapy is a cornerstone of CVD prevention and treatment; however, a subset of individuals experience partial (inability to tolerate sufficient dosage necessary to achieve therapeutic objectives due to adverse effects) or complete (inability to tolerate any dose) intolerance to statin therapy (127).”
From 10. Cardiovascular Disease and Risk Management: Standards of Care in Diabetes—2026 (2026) · cites this paper as [127]
The addition of nonstatin treatment plans to maximum tolerated statin therapy is frequently associated with improved medication-taking behavior and achievement of LDL cholesterol goals.
“While considering these alternative treatment plans, the addition of nonstatin treatment plans to maximum tolerated statin therapy should be considered, as these are frequently associated with improved medication-taking behavior and achievement of LDL cholesterol goals (127).”
From 10. Cardiovascular Disease and Risk Management: Standards of Care in Diabetes—2026 (2026) · cites this paper as [127]
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- Authors
- Cheeley, M. K., Saseen, J. J., Agarwala, A., Ravilla, S., Ciffone, N., Jacobson, T. A., Dixon, D. L., & Maki, K. C.
- Affiliations
- Grady Health System (US)
- University of Colorado Anschutz (US)
- Heart Hospital Baylor Plano (US)
- Tallahassee Memorial HealthCare (US)
- Emory University (US)
- Virginia Commonwealth University (US)
- Indiana University Bloomington (US)
- Corresponding author
- Maki, Kevin C.
- ORCID
- Venue
- Journal of Clinical Lipidology
- Publisher
- Elsevier BV
- Published
- 2022-07
- Volume
- 16
- Issue
- 4
- Pages
- 361-375
- ISSN
- 1876-4789 (ISSN-L)
- 1933-2874
- OpenAlex
- W4283205448
- Cited by
- 197
- References
- 28
- Citations by year
- 2026: 43 · 2025: 62 · 2024: 42 · 2023: 40 · 2022: 9 · 2014: 1
- FWCI
- 36.55
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Journal of clinical lipidology (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
- Health Sciences › Medicine › Family Practice › Medication Adherence and Compliance
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Cancer Research › Cancer, Lipids, and Metabolism
- Keywords
- statin intolerance, statin adverse effects, statin dose reduction, statin adherence, nocebo effect, non-statin therapy, atherogenic lipoproteins, high-risk patients
- MeSH terms
- Cardiovascular Diseases, Humans, Risk Factors, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Risk Reduction Behavior, Nocebo Effect
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