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Should high creatine kinase discourage the initiation or continuance of statins for the treatment of hypercholesterolemia?
Metabolism. 2009 Feb; 58(2):233-8.M

Abstract

Patients with high low-density lipoprotein cholesterol (LDLC) and asymptomatic high creatine kinase (CK) (>or=250 but <2500 IU/L, 10x the laboratory upper normal limit [UNL]) are often not started on statins or have statins stopped because of concern about myositis-rhabdomyolysis. In the current report, we prospectively examined the hypothesis that asymptomatic patients with high CK (>or=250 but <2500 IU/L) tolerate statins well at doses reducing LDLC to target, less than 100 mg/dL, without development of myalgia-myositis. We assessed outcomes of 3 groups of patients referred to us because of asymptomatic high CK (>or=250 but <2500 IU/L)--1 group (n = 29) on statins at referral and continued on statins, 1 group (n = 20) not on statins and started on statins, and 1 group (n = 19) not on statins and not given statins--all restudied 1 month after entry and then every 3 months. Of the 68 patients, 59 (87%) had CK greater than 1 to 3 times the UNL, 7 (10%) had CK greater than 3 to 5 times the UNL, and 2 (3%) had CK greater than 5 to 10 times the UNL. After 1.2 months of follow-up in 29 statin-->statin patients, median CK fell from 353 to 301 (P = .0018) and was 287 (P = .015) after 4 months. After 1.3 months of follow-up in 20 no statin-->statin patients, median CK fell from 397 to 292 (P = .0094) and was 419 after 4.1 months. After 1.1 months of follow-up in 19 no statin-->no statin patients, median CK fell from 392 to 323 (P = .14) and was 271 (P = .029) after 4.2 months. By repeated-measures analysis, there were no differences in entry CK among the 3 treatment groups; CK fell (P = .04) in the no statin-->no statin patients. Despite high baseline CK (48 patients with CK 1-5x the UNL, 1 with CK 5-10x UNL), no patients during follow-up on statins developed CK greater than 10 times the UNL (2500 IU/L), none discontinued statins or reduced statin dose because of myalgia-myositis, and there was no rhabdomyolysis. High pretreatment CK, particularly 1 to 5 times the UNL, should not be an impediment to start or continue statins to lower LDLC.

Authors+Show Affiliations

Cholesterol Center, Jewish Hospital, Cincinnati, OH 45229, USA. glueckch@healthall.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

19154957

Citation

Glueck, Charles J., et al. "Should High Creatine Kinase Discourage the Initiation or Continuance of Statins for the Treatment of Hypercholesterolemia?" Metabolism: Clinical and Experimental, vol. 58, no. 2, 2009, pp. 233-8.
Glueck CJ, Rawal B, Khan NA, et al. Should high creatine kinase discourage the initiation or continuance of statins for the treatment of hypercholesterolemia? Metab Clin Exp. 2009;58(2):233-8.
Glueck, C. J., Rawal, B., Khan, N. A., Yeramaneni, S., Goldenberg, N., & Wang, P. (2009). Should high creatine kinase discourage the initiation or continuance of statins for the treatment of hypercholesterolemia? Metabolism: Clinical and Experimental, 58(2), 233-8. https://doi.org/10.1016/j.metabol.2008.09.019
Glueck CJ, et al. Should High Creatine Kinase Discourage the Initiation or Continuance of Statins for the Treatment of Hypercholesterolemia. Metab Clin Exp. 2009;58(2):233-8. PubMed PMID: 19154957.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Should high creatine kinase discourage the initiation or continuance of statins for the treatment of hypercholesterolemia? AU - Glueck,Charles J, AU - Rawal,Bishal, AU - Khan,Naseer Ahmed, AU - Yeramaneni,Samrat, AU - Goldenberg,Naila, AU - Wang,Ping, PY - 2008/05/28/received PY - 2008/09/03/accepted PY - 2009/1/22/entrez PY - 2009/1/22/pubmed PY - 2009/2/28/medline SP - 233 EP - 8 JF - Metabolism: clinical and experimental JO - Metab. Clin. Exp. VL - 58 IS - 2 N2 - Patients with high low-density lipoprotein cholesterol (LDLC) and asymptomatic high creatine kinase (CK) (>or=250 but <2500 IU/L, 10x the laboratory upper normal limit [UNL]) are often not started on statins or have statins stopped because of concern about myositis-rhabdomyolysis. In the current report, we prospectively examined the hypothesis that asymptomatic patients with high CK (>or=250 but <2500 IU/L) tolerate statins well at doses reducing LDLC to target, less than 100 mg/dL, without development of myalgia-myositis. We assessed outcomes of 3 groups of patients referred to us because of asymptomatic high CK (>or=250 but <2500 IU/L)--1 group (n = 29) on statins at referral and continued on statins, 1 group (n = 20) not on statins and started on statins, and 1 group (n = 19) not on statins and not given statins--all restudied 1 month after entry and then every 3 months. Of the 68 patients, 59 (87%) had CK greater than 1 to 3 times the UNL, 7 (10%) had CK greater than 3 to 5 times the UNL, and 2 (3%) had CK greater than 5 to 10 times the UNL. After 1.2 months of follow-up in 29 statin-->statin patients, median CK fell from 353 to 301 (P = .0018) and was 287 (P = .015) after 4 months. After 1.3 months of follow-up in 20 no statin-->statin patients, median CK fell from 397 to 292 (P = .0094) and was 419 after 4.1 months. After 1.1 months of follow-up in 19 no statin-->no statin patients, median CK fell from 392 to 323 (P = .14) and was 271 (P = .029) after 4.2 months. By repeated-measures analysis, there were no differences in entry CK among the 3 treatment groups; CK fell (P = .04) in the no statin-->no statin patients. Despite high baseline CK (48 patients with CK 1-5x the UNL, 1 with CK 5-10x UNL), no patients during follow-up on statins developed CK greater than 10 times the UNL (2500 IU/L), none discontinued statins or reduced statin dose because of myalgia-myositis, and there was no rhabdomyolysis. High pretreatment CK, particularly 1 to 5 times the UNL, should not be an impediment to start or continue statins to lower LDLC. SN - 1532-8600 UR - https://www.unboundmedicine.com/medline/citation/19154957/Should_high_creatine_kinase_discourage_the_initiation_or_continuance_of_statins_for_the_treatment_of_hypercholesterolemia L2 - https://linkinghub.elsevier.com/retrieve/pii/S0026-0495(08)00356-9 DB - PRIME DP - Unbound Medicine ER -