Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 May;59(5):537-543.
doi: 10.1002/mus.26397. Epub 2019 Jan 11.

Clinical features related to statin-associated muscle symptoms

Heather M Ochs-Balcom  1 , Ly Minh Nguyen  2 , Changxing Ma  3 , Paul J Isackson  4   5 , Jasmine A Luzum  6 , Joseph P Kitzmiller  7 , Mark Tarnopolsky  8 , Michael Weisman  9 , Lisa Christopher-Stine  10 , Wendy Peltier  11   12 , Robert L Wortmann  13 , Georgirene D Vladutiu  4   14   15
Affiliations

Clinical features related to statin-associated muscle symptoms

Heather M Ochs-Balcom et al. Muscle Nerve. 2019 May.

Abstract

Introduction: Statins reduce cardiovascular disease risk and are generally well tolerated, yet up to 0.5% of statin-treated patients develop incapacitating muscle symptoms including rhabdomyolysis. Our objective was to identify clinical factors related to statin-associated muscle symptoms (SAMS).

Methods: Clinical and laboratory characteristics were evaluated in 748 statin-treated Caucasians (634 with SAMS and 114 statin-tolerant controls). Information was collected on statin type, concomitant drug therapies, muscle symptom history, comorbidities, and family history. Logistic regression was used to identify associations.

Results: Individuals with SAMS were 3.6 times (odds ratio [OR] 3.60, 95% confidence interval [CI] 2.08-6.22) more likely than statin-tolerant controls to have a family history of heart disease. Additional associations included obesity (OR 3.08, 95% CI 1.18, 8.05), hypertension (OR 2.24, 95% CI 1.33, 3.77), smoking (OR 2.08, 95% CI 1.16, 3.74), and statin type.

Discussion: Careful medical monitoring of statin-treated patients with the associated coexisting conditions may ultimately reduce muscle symptoms and lead to improved compliance. Muscle Nerve 59:537-537, 2019.

Keywords: muscle disease; rhabdomyolysis; risk factors; statin-associated muscle symptoms; statins.

PubMed Disclaimer

Conflict of interest statement

Disclosure of Conflicts of Interest: Dr. Lisa Christopher-Stine has received royalties from Inova Diagnostics for intellectual property interests related to the anti-HMG-CoA reductase assay. All other authors have no conflicts of interest.

Figures

Figures 1A-D.
Figures 1A-D.
Figure 1A) number of concomitant medications that can treat statin-associated muscle symptoms (SAMS, e.g., analgesics, skeletal muscle relaxants, and coenzyme Q10) in SAMS group vs. statin-tolerant (p<0.0001); Figure 1B) number of concomitant medications that can independently cause myopathy (e.g., systemic corticosteroids and hydroxychloroquine) in SAMS group vs. statin-tolerant group (p=0.038); Figure 1C) number of concomitant medications that can increase statin exposure (e.g. cytochrome P450 [CYP] 3A4 inhibitors in the participants treated with a CYP3A4-metabolized statin) in SAMS group vs. statin-tolerant group (p=0.524); and Figure 1D) number of concomitant medications that can decrease statin exposure (e.g. CYP3A4 inducers in the participants treated with a CYP3A4-metabolized statin) in SAMS group vs. statin-tolerant group (p=0.341). The number of medications in each of these four categories was compared between the SAMS and statin-tolerant groups via the Wilcoxon rank sum test.
See this image and copyright information in PMC

Comment in

References

    1. Stone NJ, Robinson JG, Lichtenstein AH, Bairey Merz CN, Blum CB, Eckel RH, et al. 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2014;63: 2889–2934. - PubMed
    1. Vladutiu G Genetic predisposition to statin myopathy. Curr Opin Rheumatol 2008;20: 648–655. - PubMed
    1. Thompson PD, Clarkson P, Karas RH. Statin-associated myopathy. JAMA 2003;289: 1681–1690. - PubMed
    1. Bays H Statin safety: an overview and assessment of the data−−2005. Am J Cardiol 2006;97: 6C–26C. - PubMed
    1. Yeboah J, Sillau S, Delaney JC, Blaha MJ, Michos ED, Young R, et al. Implications of the new American College of Cardiology/American Heart Association cholesterol guidelines for primary atherosclerotic cardiovascular disease event prevention in a multi ethnic cohort: Multi-Ethnic Study of Atherosclerosis (MESA). Am Heart J 2015;169: 387–395 e383. - PMC - PubMed

Publication types

MeSH terms