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Managing the underestimated risk of statin-associated myopathy.
Int J Cardiol. 2012 Sep 06; 159(3):169-76.IJ

Abstract

In clinical practice 5-10% of patients receiving statins develop myopathy, a side effect that had been systematically underestimated in the randomized controlled trials with statins. The most common manifestation of myopathy is muscle pain (usually symmetrical, involving proximal muscles) without creatinine kinase (CK) elevation or less frequently with mild CK elevation. Clinically significant rhabdomyolysis (muscle symptoms with CK elevation >10 times the upper limit of normal and with creatinine elevation) is extremely rare. Myopathy complicates the use of all statins (class effect) and is dose-dependent. The pathophysiologic mechanism of statin-associated myopathy is unknown and probably multifactorial. The risk of statin-associated myopathy can be minimized by identifying vulnerable patients (i.e. patients with impaired renal or liver function, advanced age, hypothyroidism, etc.) and/or by eliminating-avoiding statin interactions with specific drugs (cytochrome P-450 3A4 inhibitors, gemfibrozil, etc.). In symptomatic patients, the severity of symptoms, the magnitude of CK elevation and the risk/benefit ratio of statin continuation should be considered before statin treatment is discontinued. Potential strategies are the use of the same statin at a lower dose and if symptoms recur the initiation of fluvastatin XL 80 mg daily or rosuvastatin intermittently in low dose (5-10mg), combined usually with ezetimibe 10mg daily. Failure of these approaches necessitates the use of non-statin lipid lowering drugs (ezetimibe, colesevelam). In order to provide evidence based recommendations for the appropriate management of statin-intolerant patients we need randomized clinical trials directly comparing the myopathic potential of different lipid-lowering medications at comparable doses.

Authors+Show Affiliations

Second Department of Cardiology, University General Hospital, Attikon, Greece. rallidis@ath.forthnet.grNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

21813193

Citation

Rallidis, Loukianos S., et al. "Managing the Underestimated Risk of Statin-associated Myopathy." International Journal of Cardiology, vol. 159, no. 3, 2012, pp. 169-76.
Rallidis LS, Fountoulaki K, Anastasiou-Nana M. Managing the underestimated risk of statin-associated myopathy. Int J Cardiol. 2012;159(3):169-76.
Rallidis, L. S., Fountoulaki, K., & Anastasiou-Nana, M. (2012). Managing the underestimated risk of statin-associated myopathy. International Journal of Cardiology, 159(3), 169-76. https://doi.org/10.1016/j.ijcard.2011.07.048
Rallidis LS, Fountoulaki K, Anastasiou-Nana M. Managing the Underestimated Risk of Statin-associated Myopathy. Int J Cardiol. 2012 Sep 6;159(3):169-76. PubMed PMID: 21813193.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Managing the underestimated risk of statin-associated myopathy. AU - Rallidis,Loukianos S, AU - Fountoulaki,Katerina, AU - Anastasiou-Nana,Maria, Y1 - 2011/08/02/ PY - 2011/03/19/received PY - 2011/07/07/revised PY - 2011/07/10/accepted PY - 2011/8/5/entrez PY - 2011/8/5/pubmed PY - 2013/6/12/medline SP - 169 EP - 76 JF - International journal of cardiology JO - Int. J. Cardiol. VL - 159 IS - 3 N2 - In clinical practice 5-10% of patients receiving statins develop myopathy, a side effect that had been systematically underestimated in the randomized controlled trials with statins. The most common manifestation of myopathy is muscle pain (usually symmetrical, involving proximal muscles) without creatinine kinase (CK) elevation or less frequently with mild CK elevation. Clinically significant rhabdomyolysis (muscle symptoms with CK elevation >10 times the upper limit of normal and with creatinine elevation) is extremely rare. Myopathy complicates the use of all statins (class effect) and is dose-dependent. The pathophysiologic mechanism of statin-associated myopathy is unknown and probably multifactorial. The risk of statin-associated myopathy can be minimized by identifying vulnerable patients (i.e. patients with impaired renal or liver function, advanced age, hypothyroidism, etc.) and/or by eliminating-avoiding statin interactions with specific drugs (cytochrome P-450 3A4 inhibitors, gemfibrozil, etc.). In symptomatic patients, the severity of symptoms, the magnitude of CK elevation and the risk/benefit ratio of statin continuation should be considered before statin treatment is discontinued. Potential strategies are the use of the same statin at a lower dose and if symptoms recur the initiation of fluvastatin XL 80 mg daily or rosuvastatin intermittently in low dose (5-10mg), combined usually with ezetimibe 10mg daily. Failure of these approaches necessitates the use of non-statin lipid lowering drugs (ezetimibe, colesevelam). In order to provide evidence based recommendations for the appropriate management of statin-intolerant patients we need randomized clinical trials directly comparing the myopathic potential of different lipid-lowering medications at comparable doses. SN - 1874-1754 UR - https://www.unboundmedicine.com/medline/citation/21813193/Managing_the_underestimated_risk_of_statin_associated_myopathy_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0167-5273(11)00749-2 DB - PRIME DP - Unbound Medicine ER -