Statine: Nebenwirkungen – alternative Therapieoptionen

Statins are considered to be the first line treatment option for hypercholesterolemia. According to data from a global meta-analysis, the incidence of statin intolerance is estimated to be below 10%. Statin-associated muscular symptoms (SAMS) are the most common side effects of statins; however, a significant number of SAMS are attributed to the nocebo effect. A comprehensive education about the prognostic benefits of statins, along with a detailed medical history and diagnostic assessment to identify risk factors for SAMS, are decisive to avoid these side effects. If despite these measures, side effects persist or individual low-density lipoprotein cholesterol (LDL-C) target values are not achieved, alternative treatment options are available. These include the cholesterol absorption inhibitor ezetimibe, the cholesterol synthesis inhibitor bempedoic acid, proprotein convertase subtilisin/kexin type 9 monoclonal antibodies, the small interfering RNA inclisiran and the angiopoietin-like 3 inhibitor evinacumab. The individual variability in LDL‑C reduction among all lipid-lowering medications underscores the necessity for a precise and individualized treatment.