Check LLT not contraindicated or previous tolerance issues
Offer statin therapy to adults with ASCVD (as per SIGN149 Quick reference guide)
Use BRAN/shared decision-making tools to talk through treatment options
Share patient information on lipids and statins
Ensure coded for
1. dyslipidaemia and
2. at cvd risk and
3. review (see coding convention).

Are symptoms likely to be caused by the statin? Did they pre-date the statin? Systemic? Single joint or focal muscular pain is unlikely to be statin-related.
Are there pre-disposing factors or other causes e.g. alcohol excess, poorly-controlled hypothyroidism, frailty, drug-drug interaction (see BNF)
Most patients tend to tolerate an alternative type or dose of statin, and it is often worth trying several different statins until a tolerated agent is found.
Atorvastatin and rosuvastatin give the largest cholesterol reductions. But use of less potent statins, if necessary in combination with ezetimibe, will also reduce CV risk.

Where a statin is not tolerated, consider:

Stopping the statin for 4 to 6 weeks, and restarting once symptoms have resolved
An alternative statin with similar cholesterol-lowering efficacy e.g. rosuvastatin 10 mg instead of atorvastatin 20 mg
A lower dose (such as rosuvastatin 5 mg, or atorvastatin 10mg). These may also be prescribed on alternate days.
A weaker statin e.g. pravastatin 20 mg (but more likely to require ezetimibe as adjunct)
Ezetimibe - either in combination with a statin (where LDL-C remains far from target), or as a monotherapy (where multiple statins have not been tolerated)

Encourage patients to ask questions:

B - What are the Benefits of LLT?
R – What are the Risks of LLT?
A – Are there any Alternatives?
N – What if I do Nothing?