Many Patients With Statin Intolerance Self-Medicate, Despite No Link to Lowering LDL-C

Most patients with statin intolerance (SI) and statin-associated muscle symptoms (SAMS) use self-medication with supplements or over-the-counter drugs to help lower their low-density lipoprotein cholesterol (LDL-C), despite the use of self-medication not being associated with lower LDL-C levels. These results were from the prospective, observational, noninterventional, multicenter Statin Intolerance Registry study and were published in the Journal of Clinical Lipidology.¹

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How Statin Intolerance Can Lead to Self-Medication

Statin intolerance can cause major obstacles for patients trying to lower their LDL-C. With statins being a standard of care option for lowering LDL-C, being intolerant to this class of medications constitutes a major hurdle for patients with high cholesterol. Often, SI is reported due to SAMS, which can range from myalgia to renal injury. Patients with SI-related SAMS are prone to reduced quality of life, as muscle symptoms were frequent and required pain medication and increased management of their condition. Perhaps most concerningly, these patients are at increased cardiovascular risk and rarely achieve their LDL-C targets.^1-3

Because of the deterioration in quality of life in patients with SI and their increased cardiovascular risk, many may be inclined to self-medicate. Dietary supplements are an especially popular option for adults in the United States, for whom, for those aged 20 and over, 57.6% report using any dietary supplement in the last 30 days. This is despite their lack of approval from federal regulatory agencies. Although their use in general is common, the extent of dietary supplement use and self-medication among patients with SI is less known.^1,4

Therefore, investigators initiated the prospective Statin Intolerance Registry (NCT04975594), which enrolled 1111 patients with SI across 19 primary and secondary care sites in Germany. Patients were included if they had current or previous statin intake for their dyslipidemia; SI, which is considered an inability to tolerate 2 or more statins; and were aged at least 18 years.^1,5

Self-Medication is Common to Lower LDL-C Despite Ineffectiveness

A series of baseline characteristics were reported. Most of the study participants were female (57.7%), and the mean age of the cohort was 66.1 years. Furthermore, 67.2% of participants reported the current or previous use of self-medication to either treat SAMS (23.4%), lower their LDL-C levels (13.9%), or do both (29.9%), corresponding to a total use of self-medication to lower LDL-C in 43.8% and to treat 53.2% of patients, the authors wrote.¹

Self-medication use in general was associated with more frequent orthopedic disease, depression diagnoses, lower quality of life, and higher pain intensity of SAMS. There were similar proportions of patients on lipid-lowering therapy at study inclusion between participants with or without the use of self-medication, but established statin therapy at study initiation was less frequent in patients utilizing self-medication. Interestingly, self-medicators were often prescribed proprotein convertase subtilisin/kexin type 9 inhibitors.¹

Across the sample, 95.3% reported SAMS; self-medication to treat associated muscle symptoms was used by 53.2%. These self-medications included pain medication (31.1%), electrolytes (25.9%), vitamin D (23.0%), and coenzyme Q (9.3%). In a notable observation, middle-aged women were especially likely to self-medicate to alleviate SAMS.¹

The authors observed that 43.8% of patients in the population used self-medication to lower their LDL-C. These included omega-3 fatty acids (28.8%), ginger/garlic (17.6%), artichoke (8.3%), red rice (7.0%), healing clay (5.0%), and homeopathy (3.3%). Once again, middle-aged women were most likely to report self-medication to lower LDL-C. Patients reported a series of influences for why self-medication was employed, including their experience with SAMS, a recommendation from a general practitioner, or a recommendation from a pharmacist.¹

Critically, lipid values did not significantly differ in patients reporting the use of self-medication to lower LDL-C compared with those without the use of self-medication (LDL-C: 2.8 vs 2.8 mmol/L; P = .87).¹

Role of Health Care Professionals

This data highlights the prevalent role of self-medication in patients with SI to treat SAMS or lower LDL-C, especially in middle-aged women. There has been an increase in patients using supplements to lower their LDL-C over the last decades, and these results reaffirm the essential need to proactively address self-medication use during patient visits to a health care center. Pharmacists, as their role increasingly grows in health care, can be an important component in counseling patients—especially middle-aged women—on the risks of self-medication use and discussing more effective alternatives.^1,6

“Our findings suggest that proactive communication with the individual patient on the topic of supplements may represent a strategy to improve utilization of lipid-lowering medications with proven benefits and protect patients from a substantial financial burden and potential adverse effects of over-the-counter medication without proven benefit,” the study authors concluded.¹

REFERENCES

1. Stürzebecher PE, Katzmann JL, Gouni-Berthold I, et al. Self-medication to lower LDL cholesterol and to treat statin-associated muscle symptoms in patients with statin intolerance. J Clin Lipid. 2025. doi:10.1016/j.jacl.2025.07.009

2. Stürzebecher PE, Gouni-Berthold I, Mateev C, et al. Quality of life in patients with statin intolerance: a multicentre prospective registry study. Lancet Reg Health Eur. 2024;43:100981. doi:10.1016/j.lanepe.2024.100981

3. Warden BA, Guyton JR, Kovacs AC, et al. Assessment and management of statin-associated muscle symptoms (SAMS): A clinical perspective from the National Lipid Association. J Clin Lipid. 2023;17(1):19-39. doi:10.1016/j.jacl.2022.09.001

4. Mishra S, Stierman B, Gahche JJ, Potischman N. Dietary Supplement Use Among Adults: United States, 2017–2018. National Center for Health Statistics. Data Brief. 2021;399. doi:10.15620/cdc:101131

5. Statin-Intolerance Registry (SIR). National Library of Medicine. ClinicalTrials.gov Identifier: NCT04975594. Last Updated February 28, 2024. Accessed August 29, 2025. https://clinicaltrials.gov/study/NCT04975594

6. Grant JK, Dangl M, Ndumele CE, et al. A historical, evidence-based, and narrative review on commonly used dietary supplements in lipid-lowering. JLR. 2024;65(2):100493. doi:10.1016/j.jlr.2023.100493