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Self-medication to lower LDL cholesterol and to treat statin-associated muscle symptoms in patients with statin intolerance

https://doi.org/10.1007/s00392-025-02625-4

Julius L. Katzmann (Leipzig)1, P. Stürzebecher (Leipzig)1, I. Gouni-Berthold (Köln)2, I. Müller-Kozarez (Leipzig)1, C. Mateev (Leipzig)1, O. Frenzel (Leipzig)1, O. Weingärtner (Jena)3, U. Kassner (Berlin)4, U. Schatz (Dresden)5, U. Laufs (Leipzig)1

1Universitätsklinikum Leipzig Klinik und Poliklinik für Kardiologie Leipzig, Deutschland; 2Universitätsklinikum Köln Poliklinik für Endokrinologie, Diabetologie und Präventivmedizin Köln, Deutschland; 3Universitätsklinikum Jena Klinik für Innere Medizin I - Kardiologie Jena, Deutschland; 4Charité - Universitätsmedizin Berlin Medizinische Klinik für Endokrinologie und Stoffwechselmedizin Berlin, Deutschland; 5Universitätsklinikum Carl Gustav Carus an der TU Dresden Medizinische Klinik & Poliklinik III Dresden, Deutschland

 

Background
Statin intolerance (SI) is frequent and associated with increased cardiovascular risk. Self-medication with supplements or over-the-counter drugs is widespread despite limited evidence on efficacy and safety. Patients with SI may be prone to self-medication to lower LDL cholesterol (LDL-C) and to treat statin-associated muscle symptoms (SAMS).

Methods 
The Statin Intolerance Registry is an observational, prospective, multicentre study at 19 participating sites in Germany. Patients with SI were recruited 2021–2023. The use and predictors of self-medication are described in this analysis.

Results
A total of 1,111 patients were included. The mean age was 66.1 (9.9) years, 57.7% were female. The majority of patients (88.0%) had ASCVD (Table). Among all patients, 70.1% reported use of self-medication to treat SAMS (24.1%), to lower LDL-C (14.5%), or to do both (31.5%) (Fig. 1A), corresponding to a total use of self-medication to lower LDL-C in 46.0% and to treat SAMS in 55.6% of patients. The most frequent self-medications used to treat SAMS were pain medication (31.1%), electrolytes (25.9%), and vitamin D (23.0%; Fig. 1B). The most commonly used supplements to lower LDL-C were omega-3 fatty acids (28.8%) and ginger/garlic (17.6%; Fig. 1C). Reporting self-medication was strongly associated with depressive symptoms (PHQ9 score) and experience of negative statin-related information. Use of self-medication to lower LDL-C was not associated with lower LDL-C levels. More than half (54.7%) of the patients reported negative statin-related influence from other people (mainly family and friends), the media, or both (Fig. 2). This was associated with more frequent self-medication but similar LDL-C concentrations.

Conclusions
The majority of patients with SI used self-medication to lower LDL-C or to treat SAMS. Self-medication was not associated with lower LDL-C levels. Proactive communication and education on the limited evidence on efficacy and safety of supplements may improve utilization of lipid-lowering medications with proven cardiovascular benefits.

Table

 

Total

(n=1111)

Self-medication

(n=747)

No self-medication

(n=364)

P

 

Demographic data

 

 

 

 

Age (years)

66.1 (9.9)

66.0 (9.7)

66.2 (10.9)

0.81

Female

57.7

61.2

50.3

0.001

Laboratory parameters (mmol/L)

 

 

 

 

Total cholesterol

4.8 (1.7)

4.8 (1.7)

4.9 (1.7)

0.80

LDL cholesterol

2.8 (1.5)

2.8 (1.5)

2.8 (1.6)

0.72

HDL cholesterol

1.5 (0.5)

1.5 (0.4)

1.5 (0.5)

0.42

Triglycerides

1.8 (1.1)

1.8 (1.1)

1.8 (1.0)

0.43

Lipid-lowering agents

 

 

 

 

Established lipid-lowering therapy

83.4

83.7

82.8

0.72

Statin

26.9

24.9

31.0

0.03

Ezetimibe

39.2

36.3

45.1

0.005

Bempedoic acid

25.4

25.3

25.6

0.93

PCSK9 inhibitor

48.0

51.1

41.5

0.003

Cardiovascular risk factors

 

 

 

 

Hypertension

75.2

77.0

71.7

0.06

Diabetes

19.1

20.4

16.6

0.13

Active smoking

10.0

11.0

8.0

0.12

ASCVD

88.0

87.2

90.1

0.16

Comorbidities

 

 

 

 

Orthopedic disease

53.0

57.7

43.2

<0.001

Depression

10.3

12.1

6.6

0.005

Allergy

43.2

45.5

38.3

0.04

Chronic kidney disease

13.4

13.7

12.9

0.73

Psycho-social

 

 

 

 

EQ VAS score

64.8 (12.1)

62.6 (18.5)

70.0 (16.1)

<0.001

PHQ-9 score

5.8 (4.4)

6.4 (4.7)

3.4 (4.3)

<0.001

In committed relationship

73.5

77.0

66.5

<0.001

Higher education

20.6

21.6

18.7

0.27

Other parameters of interest

 

 

 

 

Intensity of muscle pain while on statin

7.0 (1.8)

7.1 (1.7)

6.7 (1.9)

0.001

SAMS-CI score

9.0 (1.8)

9.0 (1.8)

8.9 (1.9)

0.67

Expectation of adverse events on statin

6.0

7.1

3.9

0.03

Acquaintances with statin intolerance

36.6

42.4

23.9

<0.001


Figure 1



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