CoChat
Sign Up
Cited by 50Lipoproteins and Cardiovascular HealthCancer, Lipids, and MetabolismBlood Pressure and Hypertension Studies

Management of Statin Intolerant Patients in the Era of Novel Lipid Lowering Therapies: A Critical Approach in Clinical Practice

Open access
Bosco, Giosiana, Di Giacomo Barbagallo, Francesco, Spampinato, Salvatore, Lanzafame, Lorena, Di Pino, Antonino, Piro, Salvatore, Purrello, Francesco, Scicali, Roberto·2023·Journal of Clinical Medicine
DOI 10.3390/jcm12062444PMC PMC10055622
Open this paper in CoChat — free accountOpen PDF

Abstract

Statins are the cornerstone of lipid-lowering therapies effective for cardiovascular risk reduction. Although they are generally well tolerated, statin intolerance (SI) is frequent in clinical practice, and it is usually related to the onset of muscle symptoms, which are defined under the acronym SAMS (Statin-Associated Muscle Side Effects). These side effects are responsible for statin treatment discontinuation that results in increased cardiovascular risk. The National Lipid Association (NLA) has recently provided an updated definition of statin intolerance, and a distinction between complete and partial statin intolerance has been reported. The evaluation of symptom severity and the presence of muscle damage biomarker alterations make it essential to adopt a patient-centered approach aimed at obtaining a personalized therapeutic strategy. Firstly, it could be useful to administer a different statin, reduce the dosage or adopt an alternate dosage regimen. However, some patients are unable to tolerate any statin at every dosage, or despite taking statins at the maximum tolerated dose, they fail to achieve the recommended LDL-C target, and thus it is necessary to introduce a non-statin hypolipidemic treatment. Ezetimibe, proprotein-convertase subtilisin/kexin type 9 (PCSK9) inhibitors such as monoclonal antibodies (alirocumab and evolocumab) or RNA messenger silencing (inclisiran), bempedoic acid or nutraceuticals are non-statin lipid-lowering therapies that could be used as an alternative or in addition to statins to achieve an early and sustained LDL-C reduction in clinical practice. In this review, we evaluated SI management focusing on non-statin lipid lowering therapies and their implications in lipid lowering approaches in clinical practice.

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.3390/jcm12062444

Cites

10 of 10 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • The 2015 European Atherosclerosis Society Consensus Panel recommended multiple strategies to optimize statin tolerance in patients with previous SAMS based on expert opinion due to lack of sufficient data.

    “The 2015 European Atherosclerosis Society Consensus Panel Statement recommended multiple strategies to optimize statin tolerance in patients with previous SAMS based on expert opinion due to lack of sufficient data [14,15].”

    From Safety outcomes of statin vs non-statin lipid-lowering interventions in patients with prior statin-associated muscle symptoms: A systematic review and meta-analysis (2025) · cites this paper as [15]

    The References section identifies the 2015 European Atherosclerosis Society Consensus Panel statement as a work on SAMS assessment and management. Section 4 discusses multiple strategies for managing statin intolerance, but our copy does not say that the 2015 panel recommended those strategies on expert opinion because sufficient data were lacking. (LLM, conf=0.78)

    Experimental — accuracy not yet measured

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Cites

Flagged first, then by citations

Research works printed but not linked: 48

  1. [1]Borén J. Williams K.J. The Central Role of Arterial Retention of Cholesterolrich Apolipoprotein-B-Containing Lipoproteins in the Pathogenesis of Atherosclerosis: A Triumph of Simplicity Curr. Opin. Lipidol. 2016 27 473 483 10.1097/MOL.0000000000000330 27472409 · DOI · Paper page
  2. [2]Ference B.A. Ginsberg H.N. Graham I. Ray K.K. Packard C.J. Bruckert E. Hegele R.A. Krauss R.M. Raal F.J. Schunkert H. Low-Density Lipoproteins Cause Atherosclerotic Cardiovascular Disease. 1. Evidence from Genetic, Epidemiologic, and Clinical Studies. A Consensus Statement Fromthe European Atherosclerosis Society Consensus Panel Eur. Heart J. 2017 38 2459 2472 10.1093/eurheartj/ehx144 28444290 PMC5837225 · DOI · Paper page
  3. [3]Scicali R. Di Pino A. Ferrara V. Urbano F. Piro S. Rabuazzo A.M. Purrello F. New Treatment Options for Lipid-Lowering Therapy in Subjects with Type 2 Diabetes Acta Diabetol. 2018 55 209 218 10.1007/s00592-017-1089-4 29260404 · DOI
  4. [4]Stone N.J. Robinson J.G. Lichtenstein A.H. Bairey Merz C.N. Blum C.B. Eckel R.H. Goldberg A.C. Gordon D. Levy D. Lloyd-Jones D.M. 2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines J. Am. Coll. Cardiol. 2014 63 2889 2934 10.1016/j.jacc.2013.11.002 24239923 · DOI · Paper page
  5. [6]Saxon D.R. Eckel R.H. Statin Intolerance: A Literature Review and Management Strategies Prog. Cardiovasc. Dis. 2016 59 153 164 10.1016/j.pcad.2016.07.009 27497504 · DOI
  6. [7]Banach M. Cannon C.P. Paneni F. Penson P.E. Individualized Therapy in Statin Intolerance: The Key to Success Eur. Heart J. 2023 44 544 546 10.1093/eurheartj/ehac556 36254670 · DOI
  7. [8]Jia X. Al Rifai M. Saeed A. Ballantyne C.M. Virani S.S. PCSK9 Inhibitors in the Management of Cardiovascular Risk: A Practical Guidance Vasc. Health Risk Manag. 2022 18 555 566 10.2147/VHRM.S275739 35898405 PMC9309324 · DOI
  8. [10]Henney N.C. Banach M. Penson P.E. RNA Silencing in the Management of Dyslipidemias Curr. Atheroscler. Rep. 2021 23 69 10.1007/s11883-021-00968-7 34468873 PMC8410691 · DOI
  9. [11]Ballantyne C.M. Bays H. Catapano A.L. Goldberg A. Ray K.K. Saseen J.J. Role of Bempedoic Acid in Clinical Practice Cardiovasc. Drugs Ther. 2021 35 853 864 10.1007/s10557-021-07147-5 33818688 PMC8266788 · DOI
  10. [12]Cheeley M.K. Saseen J.J. Agarwala A. Ravilla S. Ciffone N. Jacobson T.A. Dixon D.L. Maki K.C. NLA Scientific Statement on Statin Intolerance: A New Definition and Key Considerations for ASCVD Risk Reduction in the Statin Intolerant Patient J. Clin. Lipidol. 2022 16 361 375 10.1016/j.jacl.2022.05.068 35718660 · DOI · Paper page
  11. [13]Grundy S.M. Stone N.J. Bailey A.L. Beam C. Birtcher K.K. Blumenthal R.S. Braun L.T. de Ferranti S. Faiella-Tommasino J. Forman D.E. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines Circulation 2019 139 e1082 e1143 10.1161/CIR.0000000000000625 30586774 PMC7403606 · DOI · Paper page
  12. [14]Stroes E.S. Thompson P.D. Corsini A. Vladutiu G.D. Raal F.J. Ray K.K. Roden M. Stein E. Tokgözoğlu L. Nordestgaard B.G. Statin-Associated Muscle Symptoms: Impact on Statin Therapy—European Atherosclerosis Society Consensus Panel Statement on Assessment, Aetiology and Management Eur. Heart J. 2015 36 1012 1022 10.1093/eurheartj/ehv043 25694464 PMC4416140 · DOI · Paper page
  13. [15]Newman C.B. Preiss D. Tobert J.A. Jacobson T.A. Page R.L. Goldstein L.B. Chin C. Tannock L.R. Miller M. Raghuveer G. Statin Safety and Associated Adverse Events A Scientific Statement from the American Heart Association Arterioscler. Thromb. Vasc. Biol. 2019 39 E38 E81 10.1161/ATV.0000000000000073 30580575 · DOI
  14. [16]Casula M. Gazzotti M. Bonaiti F. OImastroni E. Arca M. Averna M. Zambon A. Catapano A.L. Montali A. Averna M. Reported Muscle Symptoms during Statin Treatment amongst Italian Dyslipidaemic Patients in the Real-Life Setting: The PROSISA Study J. Intern. Med. 2021 290 116 128 10.1111/joim.13219 33259671 PMC8359216 · DOI
  15. [17]Fiorentino R. Chiarelli F. Statins in Children, an Update Int. J. Mol. Sci. 2023 24 1366 10.3390/ijms24021366 36674877 PMC9862804 · DOI
  16. [19]Rosenson R.S. Miller K. Bayliss M. Sanchez R.J. Baccara-Dinet M.T. Chibedi-De-Roche D. Taylor B. Khan I. Manvelian G. White M. The Statin-Associated Muscle Symptom Clinical Index (SAMS-CI): Revision for Clinical Use, Content Validation, and Inter-Rater Reliability Cardiovasc. Drugs Ther. 2017 31 179 186 10.1007/s10557-017-6723-4 28421332 PMC5427100 · DOI
  17. [20]Gulizia M.M. Colivicchi F. Arca M. Abrignani M.G. Perna G.P. Mureddu G.F. Nardi F. Riccio C. ANMCO Position Paper: Diagnostic–Therapeutic Pathway in Patients with Hypercholesterolaemia and Statin Intolerance Eur. Heart J. Suppl. 2017 19 D55 D63 10.1093/eurheartj/sux020 28751834 PMC5520756 · DOI
  18. [21]Gheorghe G. Toth P.P. Bungau S. Behl T. Ilie M. Pantea Stoian A. Bratu O.G. Bacalbasa N. Rus M. Diaconu C.C. Cardiovascular Risk and Statin Therapy Considerations in Women Diagnostics 2020 10 483 10.3390/diagnostics10070483 32708558 PMC7400394 · DOI
  19. [22]Cannon C.P. Statin Intolerance: How Common Is It and How Do We Work with Patients to Overcome It? Eur. Heart J. 2022 43 3224 3226 10.1093/eurheartj/ehac156 35325103 · DOI
  20. [23]Glueck C.J. Budhani S.B. Masineni S.S. Abuchaibe C. Khan N. Wang P. Goldenberg N. Vitamin D Deficiency, Myositis–Myalgia, and Reversible Statin Intolerance Curr. Med. Res. Opin. 2011 27 1683 1690 10.1185/03007995.2011.598144 21728907 · DOI
  21. [24]Ward N.C. Watts G.F. Eckel R.H. Statin Toxicity: Mechanistic Insights and Clinical Implications Circ. Res. 2019 124 328 350 10.1161/CIRCRESAHA.118.312782 31170055 · DOI
  22. [27]Zhang H. Plutzky J. Skentzos S. Morrison F. Mar P. Shubina M. Turchin A. Discontinuation of Statins in Routine Care Settings, A Cohort Study Ann. Intern. Med. 2013 158 526 534 10.7326/0003-4819-158-7-201304020-00004 23546564 PMC3692286 · DOI · Paper page
  23. [28]Gomez Sandoval Y.-H. Braganza M.V. Daskalopoulou S.S. Statin Discontinuation in High-Risk Patients: A Systematic Review of the Evidence Curr. Pharm. Des. 2011 17 3669 3689 10.2174/138161211798220891 22074437 · DOI
  24. [29]Jones P.H. Davidson M.H. Stein E.A. Bays H.E. McKenney J.M. Miller E. Cain V.A. Blasetto J.W. Comparison of the Efficacy and Safety of Rosuvastatin versus Atorvastatin, Simvastatin, and Pravastatin across Doses (STELLAR**STELLAR = Statin Therapies for Elevated Lipid Levels Compared Across Doses to Rosuvastatin. Trial) Am. J. Cardiol. 2003 92 152 160 10.1016/S0002-9149(03)00530-7 12860216 · DOI
  25. [31]Serban M.-C. Colantonio L.D. Manthripragada A.D. Monda K.L. Bittner V.A. Banach M. Chen L. Huang L. Dent R. Kent S.T. Statin Intolerance and Risk of Coronary Heart Events and All-Cause Mortality Following Myocardial Infarction J. Am. Coll. Cardiol. 2017 69 1386 1395 10.1016/j.jacc.2016.12.036 28302290 · DOI · Paper page
  26. [32]Banach M. Mikhailidis D.P. Statin Intolerance Cardiol. Clin. 2018 36 225 231 10.1016/j.ccl.2017.12.004 29609752 · DOI
  27. [33]Mancini G.B.J. Baker S. Bergeron J. Fitchett D. Frohlich J. Genest J. Gupta M. Hegele R.A. Ng D. Pearson G.J. Diagnosis, Prevention, and Management of Statin Adverse Effects and Intolerance: Canadian Consensus Working Group Update Can. J. Cardiol. 2016 32 S35 S65 10.1016/j.cjca.2016.01.003 27342697 · DOI
  28. [34]Penson P.E. Bruckert E. Marais D. Reiner Ž. Pirro M. Sahebkar A. Bajraktari G. Mirrakhimov E. Rizzo M. Mikhailidis D.P. Step-by-step Diagnosis and Management of the Nocebo/Drucebo Effect in Statin-associated Muscle Symptoms Patients: A Position Paper from the International Lipid Expert Panel (ILEP) J. Cachexia Sarcopenia Muscle 2022 13 1596 1622 10.1002/jcsm.12960 35969116 PMC9178378 · DOI
  29. [35]Awad K. Mikhailidis D.P. Toth P.P. Jones S.R. Moriarty P. Lip G.Y.H. Muntner P. Catapano A.L. Pencina M.J. Rosenson R.S. Efficacy and Safety of Alternate-Day Versus Daily Dosing of Statins: A Systematic Review and Meta-Analysis Cardiovasc. Drugs Ther. 2017 31 419 431 10.1007/s10557-017-6743-0 28741244 · DOI
  30. [36]Ray K.K. Molemans B. Schoonen W.M. Giovas P. Bray S. Kiru G. Murphy J. Banach M. De Servi S. Gaita D. EU-Wide Cross-Sectional Observational Study of Lipid-Modifying Therapy Use in Secondary and Primary Care: The DA VINCI Study Eur. J. Prev. Cardiol. 2021 28 1279 1289 10.1093/eurjpc/zwaa047 33580789 · DOI · Paper page
  31. [37]Ray K.K. Haq I. Bilitou A. Aguiar C. Arca M. Connolly D.L. Eriksson M. Ferrières J. Hildebrandt P. Laufs U. Evaluation of Contemporary Treatment of High- and Very High-Risk Patients for the Prevention of Cardiovascular Events in Europe—Methodology and Rationale for the Multinational Observational SANTORINI Study Atheroscler. Plus 2021 43 24 30 10.1016/j.athplu.2021.08.003 36644508 PMC9833224 · DOI
  32. [38]Pandor A. Ara R.M. Tumur I. Wilkinson A.J. Paisley S. Duenas A. Durrington P.N. Chilcott J. Ezetimibe Monotherapy for Cholesterol Lowering in 2722 People: Systematic Review and Meta-Analysis of Randomized Controlled Trials J. Intern. Med. 2009 265 568 580 10.1111/j.1365-2796.2008.02062.x 19141093 · DOI · Paper page
  33. [39]Mandraffino G. Scicali R. Rodríguez-Carrio J. Savarino F. Mamone F. Scuruchi M. Cinquegrani M. Imbalzano E. Di Pino A. Piro S. Arterial Stiffness Improvement after Adding on PCSK9 Inhibitors or Ezetimibe to High-Intensity Statins in Patients with Familial Hypercholesterolemia: A Two–Lipid Center Real-World Experience J. Clin. Lipidol. 2020 14 231 240 10.1016/j.jacl.2020.01.015 32111581 · DOI
  34. [40]Mach F. Baigent C. Catapano A.L. Koskinas K.C. Casula M. Badimon L. Chapman M.J. De Backer G.G. Delgado V. Ference B.A. 2019 ESC/EAS Guidelines for the Management of Dyslipidaemias: Lipid Modification to Reduce Cardiovascular Risk Eur. Heart J. 2020 41 111 188 10.1093/eurheartj/ehz455 31504418 · DOI · Paper page
  35. [41]McDonagh M. Peterson K. Holzhammer B. Fazio S. A Systematic Review of PCSK9 Inhibitors Alirocumab and Evolocumab J. Manag. Care Spec. Pharm. 2016 22 641 653q 10.18553/jmcp.2016.22.6.641 27231792 PMC10397903 · DOI · Paper page
  36. [43]Nissen S.E. Stroes E. Dent-Acosta R.E. Rosenson R.S. Lehman S.J. Sattar N. Preiss D. Bruckert E. Ceška R. Lepor N. Efficacy and Tolerability of Evolocumab vs Ezetimibe in Patients with Muscle-Related Statin Intolerance JAMA 2016 315 1580 10.1001/jama.2016.3608 27039291 · DOI · Paper page
  37. [46]Martirossian A.N. Goldberg A.C. Management of Patients with Statin Intolerance Best Pract. Res. Clin. Endocrinol. Metab. 2022 101714 10.1016/j.beem.2022.101714 36345572 PMC10125408 · DOI
  38. [47]Ray K.K. Raal F.J. Kallend D.G. Jaros M.J. Koenig W. Leiter L.A. Landmesser U. Schwartz G.G. Lawrence D. Friedman A. Inclisiran and Cardiovascular Events: A Patient-Level Analysis of Phase III Trials Eur. Heart J. 2023 44 129 138 10.1093/eurheartj/ehac594 36331326 PMC9825807 · DOI
  39. [48]Wright R.S. Kallend D. Raal F.J. Stoekenbroek R. Koenig W. Leiter L.A. Landmesser U. Schwartz G. Wijngaard P.L.J. Kastelein J.J.P. Pooled Safety and Efficacy of Inclisiran in Patients with Statin Intolerance (ORION-10 and ORION-11) Eur. Heart J. 2020 41 ehaa946.3009 10.1093/ehjci/ehaa946.3009 · DOI
  40. [50]Laufs U. Banach M. Mancini G.B.J. Gaudet D. Bloedon L.T. Sterling L.R. Kelly S. Stroes E.S.G. Efficacy and Safety of Bempedoic Acid in Patients with Hypercholesterolemia and Statin Intolerance J. Am. Heart Assoc. 2019 8 e011662 10.1161/JAHA.118.011662 30922146 PMC6509724 · DOI · Paper page
  41. [51]Ballantyne C.M. Laufs U. Ray K.K. Leiter L.A. Bays H.E. Goldberg A.C. Stroes E.S. MacDougall D. Zhao X. Catapano A.L. Bempedoic Acid plus Ezetimibe Fixed-Dose Combination in Patients with Hypercholesterolemia and High CVD Risk Treated with Maximally Tolerated Statin Therapy Eur. J. Prev. Cardiol. 2020 27 593 603 10.1177/2047487319864671 31357887 PMC7153222 · DOI · Paper page
  42. [52]Rubino J. MacDougall D.E. Sterling L.R. Hanselman J.C. Nicholls S.J. Combination of Bempedoic Acid, Ezetimibe, and Atorvastatin in Patients with Hypercholesterolemia: A Randomized Clinical Trial Atherosclerosis 2021 320 122 128 10.1016/j.atherosclerosis.2020.12.023 33514449 · DOI
  43. [53]Rubino J. MacDougall D.E. Sterling L.R. Kelly S.E. McKenney J.M. Lalwani N.D. Lipid Lowering with Bempedoic Acid Added to a Proprotein Convertase Subtilisin/Kexin Type 9 Inhibitor Therapy: A Randomized, Controlled Trial J. Clin. Lipidol. 2021 15 593 601 10.1016/j.jacl.2021.05.002 34172394 · DOI · Paper page
  44. [54]Pirro M. Vetrani C. Bianchi C. Mannarino M.R. Bernini F. Rivellese A.A. Joint Position Statement on “Nutraceuticals for the Treatment of Hypercholesterolemia” of the Italian Society of Diabetology (SID) and of the Italian Society for the Study of Arteriosclerosis (SISA) Nutr. Metab. Cardiovasc. Dis. 2017 27 2 17 10.1016/j.numecd.2016.11.122 27956024 · DOI · Paper page
  45. [55]Cicero A.F.G. Kennedy C. Knežević T. Bove M. Georges C.M.G. Šatrauskienė A. Toth P.P. Fogacci F. Efficacy and Safety of Armolipid Plus®: An Updated PRISMA Compliant Systematic Review and Meta-Analysis of Randomized Controlled Clinical Trials Nutrients 2021 13 638 10.3390/nu13020638 33669333 PMC7920267 · DOI · Paper page
  46. [57]Vesa C.M. Bungau S.G. Novel Molecules in Diabetes Mellitus, Dyslipidemia and Cardiovascular Disease Int. J. Mol. Sci. 2023 24 4029 10.3390/ijms24044029 36835441 PMC9961468 · DOI
  47. [58]Chen R. Lin S. Chen X. The Promising Novel Therapies for Familial Hypercholesterolemia J. Clin. Lab. Anal. 2022 36 e24552 10.1002/jcla.24552 35712827 PMC9279988 · DOI
  48. [59]Behl T. Chadha S. Sachdeva M. Sehgal A. Kumar A. Dhruv Venkatachalam T. Hafeez A. Aleya L. Arora S. Understanding the Possible Role of Endocannabinoid System in Obesity Prostaglandins Other Lipid Mediat. 2021 152 106520 10.1016/j.prostaglandins.2020.106520 33249225 · DOI

Cited by

Sorted by citations

Authors
Bosco, G., Di Giacomo Barbagallo, F., Spampinato, S., Lanzafame, L., Di Pino, A., Piro, S., Purrello, F., & Scicali, R.
Affiliations
  • University of Catania (IT)
  • Department of Clinical and Experimental Medicine, University of Catania, Internal Medicine, Garibaldi Hospital, Via Palermo 636, 95122 Catania, Italy
Corresponding author
Scicali, Roberto
ORCID
Venue
Journal of Clinical Medicine
Publisher
MDPI AG
Published
2023-03-22
Volume
12
Issue
6
Pages
2444
ISSN
2077-0383 (ISSN-L)
DOI
10.3390/jcm12062444
PMC
PMC10055622
OpenAlex
W4360615830
Cited by
50
References
10
Citations by year
2026: 12 · 2025: 22 · 2024: 15 · 2023: 1
FWCI
3.24
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of Clinical Medicine (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
Funders
Università di Catania
Topics
  • Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Cancer Research › Cancer, Lipids, and Metabolism
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
Keywords
statin intolerance, non-statin lipid-lowering therapy, ezetimibe, PCSK9 inhibitors, alirocumab, evolocumab, inclisiran, bempedoic acid, nutraceuticals, LDL cholesterol targets, statin dose reduction, muscle damage markers, cardiovascular risk

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review