Management of Statin-Associated Muscle Symptoms (SAMS) During Lipid-Lowering Therapy (LLT) for Atherosclerotic Cardiovascular Disease (ASCVD)

Statins can decrease lowering level of Low-Density Lipoprotein Cholesterol (LDL-C), and have been effective for prevention of Atherosclerotic Cardiovascular Disease (ASCVD). Lipid-Lowering Therapy (LLT) has been prevalent, but some cases develop statin intolerance. Cases with statin intolerance may show Statin-Associated Muscle Symptoms (SAMS). SAMS includes various clinical manifestations, such as general malaise, mild weakness, muscle pain and cramps with about 5-10% of incidence in clinical practice. European Atherosclerosis Society (EAS) consensus panel included three SAMS types, which are myalgias, myositis and rhabdomyolysis. There is a proposal of algorithm for the management of SAMS with several stages such as genesis, exams, diagnosis, evaluation and management. As non-statin based therapies, ezetimibe and Proprotein Convertase Subtilisin/Kexin type 9 (PCSK9) inhibitors can be added and applied.

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