Instead of the label statin intolerance, the present guideline prefers statin-associ- ated side effects because the large majority of patients are able to tolerate statin rechallenge with an alterna- tive statin or alternative regimen, such as reduced dose or in combination with nonstatins. Although infrequent or rare in clinical trials, statin-associated side effects can be challenging to assess and manage.S5-25,S5-26 The most frequent are SAMS. SAMS usually are subjective myalgia, reported observationally in 5% to 20% of SAMS often result in nonadherence and can adversely impact ASCVD outcomes.S5-27 S5-29 Statins modestly increase risk of incident diabetes mel- litus in susceptible individuals,S5-8 S5-11 but this should not be cause for discontinuation (Table 11). The present guideline recommends a comprehensive approach to statin-associated symptoms. The clinician should reas- sess, rediscuss, and encourage rechallenge as the ini- tial approach unless side effects are severe. Ongoing communication is integral to patient care, as is regular monitoring to check for adherence, adequacy of re- sponse, new associated symptoms, and reaffirmation Recommendations for Statin Safety and Statin-Associated Side Effects (Continued) COR LOE Recommendations CLINICAL STATEMENTS AND GUIDELINES Recommendation-Specific Supportive Text 1. A clinician patient risk discussion focused on indi- cations, benefits, risks of statin-associated side effects, and patient concerns and preferences should precede initiation of statin treatment.S5-2 This dialogue is the foundation of a longitudinal care partnership that is based on informed deci- sion-making. Future encounters should address statin response, emphasize adherence, and reaf- firm benefit. Statin-associated symptoms should be comprehensively assessed, and because most can be well managed,S5-3 S5-7 the goal should be to optimize patient-centered strategies for ASCVD prevention. 2. 