SummaryLDL cholesterol goals by risk category: below 116 mg/dl at low risk, below 100 mg/dl at moderate risk, below 70 mg/dl at high risk, below 55 mg/dl at very high risk. Statins first, ezetimibe second, PCSK9 inhibitors third. Statin interactions run mainly through CYP3A4 (atorvastatin, simvastatin) and OATP1B1; monitoring of ALT and CK is defined.

SummaryDefines statin-associated muscle symptoms as symmetric proximal muscle pain, weakness or stiffness beginning within weeks to months of a statin start and improving within weeks of withdrawal; CK is usually normal or mildly raised. Management: withdraw, wait for symptoms to resolve, then rechallenge with the same or a different statin at a lower dose or alternate-day dosing; most patients tolerate a second statin. Non-statin therapy for those who cannot.