Update on statin-associated myopathy symptoms in the view of new clinical management strategies

Purpose of review: Purpose of this review is to highlight the recent findings in terms of clinical aspects, pathogenic mechanisms and managements of statin associated muscle symptoms (SAMS), and focusing on the use of novel therapeutic alternatives in clinical practice. Recent findings: While extensive research has been conducted on SAMS, the precise mechanisms remain unclear. Recent findings continue to explore various aspects, including potential risk factors, diagnostic approaches, and management strategies. Managing SAMS involves a careful assessment to confirm the diagnosis, a stepwise approach to treatment that may include dose adjustments, switching statins, considering alternate-day dosing, and exploring nonstatin therapies, all while prioritizing patient well being and cardiovascular risk reduction through shared decision-making and ongoing monitoring. In recent years, the therapeutic landscape has expanded with the introduction of several novel lipid-lowering agents, providing valuable alternatives for both statin-tolerant and statin-intolerant patients but their use in clinical practice is still limited because of high costs, regulatory limitations and type of administration. Summary: Given the increasing use of both traditional and emerging lipid-lowering therapies, a clear understanding of their comparative safety, particularly regarding musculoskeletal adverse effects, is essential for guiding clinical decision-making.