Lipid Medications

Myalgias (muscle aches) are the most common side effect, reported in 5-10% of patients, though nocebo effects are significant. True statin-associated muscle symptoms (SAMS) may be lower. Other side effects include elevated liver enzymes (check baseline ALT, no routine monitoring needed), new-onset diabetes (small absolute risk, CV benefit outweighs), and rarely rhabdomyolysis. If myalgias occur: try dose reduction, alternate-day dosing, or switch to a different statin before stopping.

Add ezetimibe when LDL is not at goal on maximally tolerated statin (very high-risk: LDL >= 70; high-risk: LDL >= 100). Add PCSK9 inhibitor if still not at goal on statin + ezetimibe for very high-risk ASCVD patients. Consider bempedoic acid for truly statin-intolerant patients. Icosapent ethyl for elevated TG (135-499) with ASCVD or diabetes on maximally tolerated statin.

Baseline fasting lipid panel before starting therapy. Repeat at 4-12 weeks after starting or adjusting therapy to assess response. Once stable and at goal, annual monitoring is sufficient. For patients on high-intensity statins for secondary prevention, check lipids to ensure >= 50% LDL reduction from baseline.