Lowering serum lipid levels is part of the foundation of treating and preventing 
clinically significant cardiovascular disease. Recently, the American Heart 
Association/American College of Cardiology released cholesterol guidelines which 
advocate for high efficacy statins rather than LDL-c goals for five patient 
subgroups at high risk for cardiovascular disease. Therefore, it is critical 
that clinicians have an approach for managing side-effects of statin therapy. 
Statins are associated with myopathy, transaminase elevations, and an increased 
risk of incident diabetes mellitus among some patients; connections between 
statins and other processes, such as renal and neurologic function, have also 
been studied with mixed results. Statin-related adverse effects might be 
minimized by careful assessment of patient risk factors. Strategies to continue 
statin therapy despite adverse effects include switching to another statin at a 
lower dose and titrating up, giving intermittent doses of statins, and adding 
non-statin agents. Non-statin lipid-lowering drugs have their own unique 
limitations. Management strategies and algorithms for statin-associated 
toxicities are available to help guide clinicians. Clinical practice should 
emphasize tailoring therapy to address each individual's cholesterol goals and 
risk of developing adverse effects on lipid-lowering drugs.