Given evidence statins decrease cardiovascular morbidity and mortality, LDL reduction with statins is a mainstay in the treatment and prevention of cardiovascular disease. Despite their efficacy, statins can cause significant side effects in an estimated 5–10% of patients, commonly resulting in discontinuation of the drug. This review focuses on the pathophysiology, epidemiology and research surrounding statin-induced myopathy and hepatotoxicity. It will provide guidance in terms of diagnosis and proposed management of statin intolerance. Numerous side effects aside from myopathy and hepatotoxicity have been cited in the literature, and the most pertinent ones will be discussed here. Other potential alternatives to statin therapy will also be highlighted. Although much work needs to be done to demonstrate morbidity and mortality benefits of alternatives to statins, there are new therapies that hold promise within hyperlipidemia management.