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Review
. 2015 Oct 30;112(44):748-55.
doi: 10.3238/arztebl.2015.0748.

Treatment Options for Statin-Associated Muscle Symptoms

Ulrich Laufs  1 , Hubert Scharnagl, Martin Halle, Eberhard Windler, Matthias Endres, Winfried März
Affiliations
Review

Treatment Options for Statin-Associated Muscle Symptoms

Ulrich Laufs et al. Dtsch Arztebl Int. .

Abstract

Background: About 4.6 million persons in Germany are now taking statins, i.e., drugs that inhibit the enzyme 3-hydroxy-3-methylglutaryl-coenzyme A (HMGCoA) reductase. Statins lower the concentration of low-density lipoproteins (LDL) and thereby lessen the rate of cardiovascular events; the size of this effect depends on the extent of lowering of the LDL cholesterol concentration. Muscle symptoms are a clinically relevant side effect of statin treatment.

Methods: This review is based on pertinent publications retrieved by a selective literature search, and on the current recommendations of the European Atherosclerosis Society.

Results: At least 5% of patients taking statins have statin-associated muscle symptoms (SAMS). The etiology of SAMS is heterogeneous. SAMS may seriously impair quality of life and cause complications of variable severity, up to and including rhabdomyolysis (in about 1 in 100,000 cases). SAMS often lead to a reduction in the prescribed dose of the statin, while also negatively affecting drug adherence. More than 90% of patients with SAMS can keep on taking statins over the long term and gain the full clinical benefit of statin treatment after a switch to another type of statin or a readjustment of the dose or frequency of administration. If the LDL cholesterol concentration is not adequately lowered while the patient is taking a statin in the highest tolerable dose, combination therapy is indicated.

Conclusion: SAMS are important adverse effects of statin treatment because they lessen drug adherence. Patients with SAMS should undergo a thorough diagnostic evaluation followed by appropriate counseling. In most cases, statins can be continued, with appropriate adjustments, even in the aftermath of SAMS.

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Figures

Figure
Figure
Flow-chart for statin-associated muscle symptoms (modified according to Stroes et al. [2]). CK, creatine kinase; ULN, upper limit of normal (of the reference range); LDL, low-density protein; PCSK9, proprotein convertase subtilisin/kexin type 9; CETP, cholesteryl ester transfer protein
See this image and copyright information in PMC

Comment in

  • Creatine Kinase Levels After Exercise.
    Kindermann W. Kindermann W. Dtsch Arztebl Int. 2016 May 13;113(19):344. doi: 10.3238/arztebl.2016.0344a. Dtsch Arztebl Int. 2016. PMID: 27232364 Free PMC article. No abstract available.
  • Statins Impede a Healthy Lifestyle.
    Wenderlein JM. Wenderlein JM. Dtsch Arztebl Int. 2016 May 13;113(19):345. doi: 10.3238/arztebl.2016.0344c. Dtsch Arztebl Int. 2016. PMID: 27232366 Free PMC article. No abstract available.

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