On a statin, or is one indicated? Yes
statin-tolerabilityFewer than 5 people have reached this rule so farWhat to do about muscle aches before stopping, and what the evidence says about them
No clinician has signed off this rule yet. It reflects our reading of the guidelines cited below, which has not been independently checked.
Word for word, as generated for the example person below. Figures in the text are theirs.
If a statin causes muscle aches, there's a whole ladder to try before giving up on it — and it's worth climbing.
In order: stop briefly to confirm the symptoms actually track with the drug; recheck on a lower dose or a different statin (rosuvastatin and pravastatin are less likely to cause muscle symptoms); try every-other-day dosing; then add or switch to ezetimibe or bempedoic acid. Worth knowing: in SAMSON, patients who were certain statins caused their symptoms took statin, placebo, and nothing in blinded rotation — about 90% of the symptom burden occurred just as much on placebo. That doesn't mean the pain isn't real, but it does mean most people who think they can't take any statin eventually can.
Outcome-provenTested in randomised trials measuring heart attacks, strokes, or death, not a stand-in for them.· checked 2026-09-12
SAMSON trial (NEJM 2020) — statin side effects, blinded n-of-1 · Practical guidance
“Borderline risk + high Lp(a)” — an illustrative profile, not a real user.
Cited by the recommendations above.
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Runs in lib/engine/preventionEssentials.ts as statin-tolerability.