Muscle problems and other adverse symptoms associated with statin use are 
frequent reasons for non-adherence and discontinuation of statin therapy, which 
results in inadequate control of hyperlipidemia and increased cardiovascular 
risk. However, most patients who experience adverse symptoms during statin use 
are able to tolerate at least some degree of statin therapy. Given the profound 
cardiovascular benefits derived from statins, an adequate practical approach to 
statin intolerance is, therefore, of great clinical importance. Statin 
intolerance can be defined as the occurrence of myalgia or other adverse 
symptoms that are attributed to statin therapy and that lead to its 
discontinuation. In reality, these symptoms are actually unrelated to statin use 
in many patients, especially in those with atypical presentations following long 
periods of treatment. Thus, the first step in approaching patients with adverse 
symptoms during the course of statin therapy is identification of those patients 
for whom true statin intolerance is unlikely, since most of these patients would 
probably be capable of tolerating adequate statin therapy. In patients with 
statin intolerance, an altered dosing regimen of very low doses of statins 
should be attempted and, if tolerated, should gradually be increased to achieve 
the highest tolerable doses. In addition, other lipid-lowering drugs may be 
needed, either in combination with statins, or alone, if statins are not 
tolerated at all. Stringent control of other risk factors can aid in reducing 
cardiovascular risk if attaining lipid treatment goals proves difficult.