About 70% of studied patients were taking concomitant lipid-lowering prescription medications and supplements. The intermittent dosing group took a significantly higher rate of supplements compared to the daily dosing group and discontinuation group (52.3% versus 41.4% versus 46.2%, respectively), including red yeast rice, Metamucil , plant stanols/sterols, omega-3 fatty acids, and coenzyme Q10 (CoQ10). Also, both the intermittent dosing and discontinuation groups had higher rates of niacin and bile acid sequestrant use. There was a non-significant trend toward a decrease in all-cause mortality at eight years for intermittent statin dosing as compared to statin discontinuation, while mortality was similar in intermittent and daily dosing groups. The most common category of statin-related events is musculoskeletal symptoms, which can be misattributed to statins and may lead to statin discontinuation and a reluctance to restart treatment. A meta-analysis not included in this CPG s systematic evidence review, Riaz et al. (2017), included over 125,000 patients and concluded that rates of myopathy were similar between the statin and placebo group (OR: 1.2, 95% CI: 0.88 1.62).[117] The absolute incidence of serious muscle injury (e.g., rhabdomyolysis) is very low and estimated to be about 3.4 per 100,000 person-years.[118] Some risk factors may predispose patients to statin-induced muscle toxicity, including drug-drug interactions, impaired hepatic or renal function, hypothyroidism, advanced age, rheumatologic disorders, vitamin D deficiency, and alcoholism.[56,62,73] Those factors need to be considered when evaluating statin intolerance. A washout period (i.e., a short-term interruption of a statin), should be implemented to evaluate whether the perceived adverse event is related to a statin. The optimal duration of the washout period was not clear in the available evidence. Based on statin half-lives, an interruption of 2 4 weeks is reasonable. 