Practical Tip
Always confirm that there is an indication for statin use which, if present, would suggest that benefits, clearly communicated to the patient, far outweigh the potential occurrence of any of the many side effects purported to be associated with statin use. Assess patient features that might limit dosage or preclude use of statins (eg potential drug-drug interactions) and always emphasize dietary, weight and exercise interventions to facilitate achievement of lipid goals and other benefits of comprehensive, CV prevention. Shared decision making remains key.

Recommendation 1
We recommend that despite concerns about a variety of possible adverse effects, all purported statin-associated symptoms should be evaluated systematically, incorporating observation during cessation, re-initiation (same or different statin, same or lower potency, same or decreased frequency of dosing) to identify a tolerated, statin-based therapy for chronic use (Strong recommendation, Low Quality Evidence).

Recommendation 2
We recommend that vitamins, minerals, or supplements for symptoms of myalgia perceived to be statin-associated not be used (Strong Recommendation, Low Quality Evidence).

Values and preferences
Always confirm that there is an indication for statin use which, if present, would suggest that benefits, clearly communicated to the patient, far outweigh the potential occurrence of any of the many side effects purported to be associated with statin use. Assess patient features that might limit dosage or preclude use of statins (eg potential drug-drug interactions) and always emphasize dietary, weight and exercise interventions to facilitate achievement of lipid goals and other benefits of comprehensive, CV prevention.