Statins are one of the most commonly prescribed drugs in clinical practice. They are usually well tolerated and effectively prevent cardiovascular events. Most adverse effects associated with statin therapy are muscle-related. The recent statement of the European Atherosclerosis Society (EAS) has focused on statin associated muscle symptoms (SAMS), and avoided the use of the term 'statin intolerance'. Although muscle syndromes are the most common adverse effects observed after statin therapy, excluding other side effects might underestimate the number of patients with statin intolerance, which might be observed in 10-15% of patients. In clinical practice, statin intolerance limits effective treatment of patients at risk of, or with, cardiovascular disease. Knowledge of the most common adverse effects of statin therapy that might cause statin intolerance and the clear definition of this phenomenon is crucial to effectively treat patients with lipid disorders. Therefore, the aim of this position paper was to suggest a unified definition of statin intolerance, and to complement the recent EAS statement on SAMS, where the pathophysiology, diagnosis and the management were comprehensively presented.

1 P Apollo Hospital New Delhi India

1st Department Of Internal Medicine Pavol Jozef Safarik University and Louis Pasteur University Hospital Košice Slovakia

1st Department of Medicine University of Pecs Pecs Hungary

2nd Propedeutic Department of Internal Medicine Medical School Aristotle University of Thessaloniki Hippocration Hospital Thessaloniki Greece

Biomedical Department of Internal Medicine and Medical Specialties University of Palermo Palermo Italy

California Heart Associates CA USA

Cardiology Division Department of Medicine Westchester Medical Center New York Medical College Valhalla New York USA

Department of Atherosclerosis Cardiology Research Center Moscow Russia

Department of Cardiology Queen Giovanna University Hospital Sofia Bulgaria

Department of Clinical Biochemistry Royal Free Campus University College London Medical School University College London London UK

Department of Clinical Biochemistry SQUH Muscat Oman

Department of Epidemiology University of Alabama at Birmingham Birmingham AL USA

Department of Hypertension Chair of Nephrology and Hypertension Medical University of Lodz Lodz Poland

Department of Internal Medicine and Clinical Pharmacology Medical University of Lodz Poland

Department of Internal Medicine Charles University Praha Czech Republic

Department of Lipidology Point Medical Dijon France

Department of Medicine Schools of Pharmacy and Medicine The University of Kansas Medical Center Kansas City KS USA

Department of Medicine University of Chicago Medicine Chicago IL USA

Department of Primary Care and Public Health School of Public Health Imperial College London London UK

Department of Vascular Medicine Academic Medical Center University of Amsterdam Amsterdam The Netherlands

Department of Vascular Medicine Preventive Cardiology Unit University Medical Centre Ljubljana Slovenia Internal Medicine Faculty of Medicine University of Ljubljana Ljubljana Slovenia

Heart Disease Prevention Program Division of Cardiology University of California Irvine Irvine CA USA

Institute of Medical Physiology Faculty of Medicine University of Belgrade Belgrade Serbia

Mater Hospital University of Queensland St Lucia QLD Australia

South Australian Health and Medical Research Institute and University of Adelaide Adelaide Australia

The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease Baltimore MD USA

University of Illinois College of Medicine Peoria IL USA

University of Medicine and Pharmacy Victor Babes Timisoara Romania

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