In patients with statin-associated side effects, it is recommended that CK be measured in the case of severe SAMS and in the presence of objective mus- cle weakness. After baseline liver transaminases, the FDA recommends measuring transaminases (aspar- tate aminotransferase [serum glutamic-oxaloacetic transaminase] and alanine aminotransferase [serum glutamic-pyruvic transaminase]) if there are signs or symptoms suggesting hepatotoxicity.S5-13 S5-15 upper limit of normal) is an infrequent statin-associ- ated side effect that often resolves with dose reduc- tion or rechallenge with alternative statins.S5-1,S5-22 Severe statin-associated hepatotoxicity is rare, and the incidence is not impacted by routine monitor- ing of transaminases.S5-34 A thorough evaluation for nonstatin etiologies is warranted when signifi- cant transaminase elevation persists. Importantly, statins are not contraindicated in patients with increased ASCVD risk with chronic, stable liver dis- ease (eg, nonalcoholic fatty liver), and limited data suggest potential benefit.S5-16 S5-18 8. Severe statin-associated side effects are rare, and recurrent SAMS are infrequent when a thorough reassessment and management strategy of reas- sess, rediscuss, and rechallenge is used. In patients at increased ASCVD risk with severe statin-asso- ciated side effects or recurrent SAMS, nonstatin therapy should be considered when there is net 9. The clinical diagnosis of SAMS remains chal- lenging, given that the majority of symptoms are subjective and definitive diagnostic criteria do not exist.S5-13 Multiple potential mechanisms have been suggested to contribute to SAMS, CLINICAL STATEMENTS AND GUIDELINES including depletion of ubiquinone or coenzyme Q10. Available evidence, however, does not sup- port the use of coenzyme Q10 supplementation for routine use in patients treated with statins or for the treatment of SAMS.S5-20,S5-21 10. 