Adverse effects of statins : how should cardiologists and general physicians manage them in clinical practice?

A key role in the pathogenesis of atherosclerotic lesions is represented by cholesterol deposition in the arterial vessel wall, and a large body of international, randomised, controlled clinical trials have shown that the clinical use of drugs that are active in lowering serum cholesterol concentrations, such as competitive inhibitors of hydroxymethylglutaryl coenzyme A (HMG-CoA) reductase (collectively defined as 'statins'), produces significant reductions of cardiovascular mortality and morbidity through different and sometimes not fully elucidated mechanisms. However, it is important to consider that the patients who get the largest benefit from taking statins (frequently at high doses) are at the same time those with the highest risk of presenting adverse effects related to the use of these drugs. These patients are usually elderly, hypertensive and diabetic, often have renal function impairment or other associated clinical conditions and are usually receiving multiple therapies. Consequently, these patients may be exposed to adverse effects caused by pharmacological interactions of other drug classes with statins. Because of this, cardiologists need to be properly aware of the beneficial potential of these compounds but also of the potential limits and risks associated with the use of statins in the population at large.This article is aimed at examining the safety profile linked to the clinical use of statins and suggesting an adequate management to prevent the potential adverse effects while taking advantage of the outstanding cardiovascular benefits of statins.