• Joana Tendais Almeida, Ana Luísa Esteves, Filipa Martins, and Isabel Palma.
• Departamento de Medicina Geral e Familiar. Unidade de Cuidados de Saúde Personalizados Almeirim. Agrupamento dos Centros de Saúde Lezíria. Santarém. Portugal.
• Acta Medica Port. 2020 Jan 3; 33 (1): 49-57.

IntroductionStatins are among the most effective drugs in lowering cholesterol levels and, consequently, in reducing cardiovascular mortality and morbidity. Although generally well tolerated, they have adverse effects that may reduce patient adherence to therapy. The objective of this evidence-based review is to summarize the evidence on the effectiveness of alternative management strategies in patients with intolerance to statins.Material And MethodsA literature search including clinical practice guidelines, systematic reviews and meta-analyses was conducted, in January 2017, in major international databases, and considered articles published in the last 10 years. The search was complemented with research papers published over the past three years and found in the PubMed database. The level of evidence and strength of recommendation were determined using the scale Strength of Recommendation Taxonomy - SORT.ResultsWe included eight guidelines, six systematic reviews and one research paper.DiscussionThe strategies proposed by the different studies vary according to the severity of symptoms of intolerance including maintenance of the statin therapy (dose reduction, addition of a statin of equal or lower intensity or alternate days' uptake) and lipid-lowering therapy with other drugs (ezetimibe monotherapy or association with statin tolerated dose). Supplementation with coenzyme Q10 or vitamin D, in order to improve adherence to treatment with statins, is not recommended.ConclusionThis review highlights some alternatives to address patients' intolerance to statins; however, these are mostly based on recommendations with low to moderate evidence. Therefore, further research with randomized studies involving greater number of patients is required, in order to obtain a more robust recommendation.

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