A plethora of evidence supports the use of statin therapy for primary and secondary prevention of atherosclerotic cardiovascular disease (ASCVD), yet residual risk among high-risk patients receiving statin therapy remains high. Moreover, statin-associated muscle symptoms and other statin-associated adverse effects (e.g., increased risk of diabetes mellitus) limit the use of statins in high-risk patient populations. Of particular concern are individuals with established ASCVD, familial hypercholesterolemia (FH), or diabetes mellitus plus multiple ASCVD risk factors, all of whom require high-intensity statins, which are more commonly associated with an increased risk of adverse effects.
Sisson EM, Pamulapati L, Bucheit JD, Kelly MS, Dixon DL. Evolving role of non-statin therapy for the management of dyslipidemia and cardiovascular risk reduction: Past, present, and future. Pharmacotherapy. 2017;38(2):164-171. doi:10.1002/phar.2074