A recent study published in the journal of Clinical Lipidology reveals that many patients experiencing statin intolerance (SI) adn statin-associated muscle symptoms (SAMS) resort to self-medication with supplements or over-the-counter drugs to manage their low-density lipoprotein cholesterol (LDL-C) levels. Though,this practice does not appear to be effective in actually lowering LDL-C.

How Statin Intolerance Can Lead to Self-Medication

Statin intolerance poses significant challenges for patients aiming to reduce their LDL-C. Statins are a standard treatment for lowering LDL-C, so intolerance to these medications creates a major obstacle for individuals with high cholesterol. SI is frequently enough linked to SAMS, which can manifest as myalgia or even renal injury. Patients with SI-related SAMS often experience a reduced quality of life, with frequent muscle symptoms requiring pain medication and increased condition management. Alarmingly, these patients face a higher cardiovascular risk and often fail to reach their LDL-C targets.

The decline in quality of life and increased cardiovascular risk associated with SI can drive patients to self-medicate. Dietary supplements are a popular choice among adults in the United States, with 57.6% of those aged 20 and over reporting their use in the past 30 days. This is despite the fact that these supplements lack approval from federal regulatory agencies. While supplement use is common,the extent of self-medication among patients with SI has been less clear.

To investigate this further, researchers initiated the prospective Statin Intolerance Registry (NCT04975594), enrolling 1111 patients with SI across 19 primary and secondary care sites in Germany. Participants included those with current or previous statin intake for dyslipidemia, SI (defined as intolerance to two or more statins), and were at least 18 years old.

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

The study reported several baseline characteristics. The majority of participants were female (57.7%), with a mean age of 66.1 years. A significant 67.2% reported current or previous self-medication use to treat SAMS (23.4%), lower LDL-C levels (13.9%), or both (29.9%). This translates to 43.8% using self-medication to lower LDL-C and 53.2% to treat SAMS.

Self-medication use was associated with more frequent orthopedic disease, depression diagnoses, lower quality of life, and higher pain intensity of SAMS. While the proportions of patients on lipid-lowering therapy at study inclusion were similar between those who did and did not use self-medication, established statin therapy at study initiation was less frequent in self-medicating patients. Interestingly, these patients were frequently enough prescribed proprotein convertase subtilisin/kexin type 9 inhibitors.

Of the participants,95.3% reported SAMS, with 53.2% using self-medication to treat these symptoms. Common self-medications included pain medication (31.1%), electrolytes (25.9%), vitamin D (23.0%),and coenzyme Q (9.3%). Notably,middle-aged women were particularly likely to self-medicate to alleviate SAMS.

The study found that 43.8% of patients used self-medication to lower their LDL-C,including 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%). Again, middle-aged women were the most likely to report self-medication for this purpose. Patients cited various reasons for self-medicating, including their experience with SAMS, recommendations from general practitioners, or advice from pharmacists.

Though, and critically, lipid values did not substantially differ between patients who used self-medication to lower LDL-C and those who did not (LDL-C: 2.8 vs 2.8 mmol/L; P = .87).

Role of Health Care Professionals

These findings highlight the widespread use of self-medication among patients with SI to treat SAMS or lower LDL-C, particularly among middle-aged women. With the increasing use of supplements to lower LDL-C, it is crucial to proactively address self-medication during patient visits to healthcare centers. Pharmacists, with their expanding role in healthcare, can play a vital part in counseling patients, especially middle-aged women, about the risks of self-medication and discussing more effective alternatives.

The study authors concluded, “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.”

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