I find that many patients who say they can’t tolerate statins can in fact tolerate low doses, either halving the daily dose or taking their therapy 3 days a week. This can still deliver good results on serum lipids, with or without a second agent.

Ezetimibe has been an important drug for many who can’t get to LDL target despite using a statin. Cholestyramine can be an option in this role, but most patients find it less, not more easily tolerated, due to GI side effects.

Low-dose statin therapy decreases cardiovascular events by a third, while high dose cuts up to 50%. There is dissociation between what clinically can be achieved in randomized controlled trials and the amount of fear and side effects that many of our patients complain of. Rhabdomyolysis is very rare and the risk of a statin killing a patient is in the order of 1 in a million. There are approximately 80,000 cardiovascular deaths in Canada per year. In a number of series of randomized controlled trials, 30% of patients on active treatment with a statin complained of a side effect — and so did 30% of placebo-treated patients! Unfortunately, arthritis and soreness are extremely common in this age group. The vast majority of aches are unrelated to the drug — witness the equally huge range of musculoskeletal complaints in patients who aren’t taking life-saving cholesterol drugs.

If the CK is normal you may try statins at a reduced frequency such as 3 days a week, accompanied by coenzyme Q10 at least 100 mg a day in non-pill form to increase bio-availability.

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