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Management Strategies for Statin-Associated Muscle Symptoms: How Useful Is Same-Statin Rechallenge?
Can J Cardiol. 2017 05; 33(5):666-673.CJ

Abstract

BACKGROUND

Statin-associated muscle symptoms (SAMS) are common. Rechallenge with the same statin (same-statin rechallenge) has recently been included as part of a proposed scoring index for diagnosing SAMS, but data regarding tolerability and efficacy of same-statin rechallenge, compared with other strategies, is minimal. In this study we evaluated the tolerability, percent change in low-density lipoprotein cholesterol (LDL-C), and proportion of patients achieving their LDL-C targets among 3 common management strategies-same-statin rechallenge, switching to a different statin (statin switch), and use of nonstatin medications only.

METHODS

We performed a retrospective analysis of 118 patients referred to our tertiary care centre for management of SAMS, defined as development of muscle-related symptoms with 2 or more statins. Baseline and last follow-up lipid parameters were documented. Patients were classified as tolerant of a strategy if, at their last follow-up, they remained on that strategy.

RESULTS

After a median follow-up of 17 months, most (n = 79; 67%) patients were able to tolerate a statin. Tolerability was similar among the 3 treatment strategies (71% same-statin rechallenge vs 53% statin switch vs 57% for nonstatin therapy only; P = 0.11). Those in the same-statin rechallenge and statin switch groups achieved greater LDL-C reductions compared with those who only tolerated nonstatins (-38.8 ± 3.4% vs -36.4 ± 2.9% vs -17.3 ± 4.5%; P = 0.0007). A greater proportion of patients in the same-statin rechallenge group achieved their target LDL-C compared with those in the nonstatin therapy only group (50% vs 15%; odds ratio, 6.8; 95% confidence interval, 1.5-40.7; P = 0.04).

CONCLUSIONS

Among individuals with a history of SAMS, most will tolerate statin therapy. Same-statin rechallenge was highly tolerable and efficacious. Thus, same-statin rechallenge might warrant increased utilization.

Authors+Show Affiliations

Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada. Electronic address: tisjoy@hotmail.com.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28449837

Citation

Brennan, Emily T., and Tisha R. Joy. "Management Strategies for Statin-Associated Muscle Symptoms: How Useful Is Same-Statin Rechallenge?" The Canadian Journal of Cardiology, vol. 33, no. 5, 2017, pp. 666-673.
Brennan ET, Joy TR. Management Strategies for Statin-Associated Muscle Symptoms: How Useful Is Same-Statin Rechallenge? Can J Cardiol. 2017;33(5):666-673.
Brennan, E. T., & Joy, T. R. (2017). Management Strategies for Statin-Associated Muscle Symptoms: How Useful Is Same-Statin Rechallenge? The Canadian Journal of Cardiology, 33(5), 666-673. https://doi.org/10.1016/j.cjca.2017.02.013
Brennan ET, Joy TR. Management Strategies for Statin-Associated Muscle Symptoms: How Useful Is Same-Statin Rechallenge. Can J Cardiol. 2017;33(5):666-673. PubMed PMID: 28449837.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Management Strategies for Statin-Associated Muscle Symptoms: How Useful Is Same-Statin Rechallenge? AU - Brennan,Emily T, AU - Joy,Tisha R, Y1 - 2017/03/02/ PY - 2016/11/25/received PY - 2017/02/16/revised PY - 2017/02/26/accepted PY - 2017/4/29/entrez PY - 2017/4/30/pubmed PY - 2017/8/3/medline SP - 666 EP - 673 JF - The Canadian journal of cardiology JO - Can J Cardiol VL - 33 IS - 5 N2 - BACKGROUND: Statin-associated muscle symptoms (SAMS) are common. Rechallenge with the same statin (same-statin rechallenge) has recently been included as part of a proposed scoring index for diagnosing SAMS, but data regarding tolerability and efficacy of same-statin rechallenge, compared with other strategies, is minimal. In this study we evaluated the tolerability, percent change in low-density lipoprotein cholesterol (LDL-C), and proportion of patients achieving their LDL-C targets among 3 common management strategies-same-statin rechallenge, switching to a different statin (statin switch), and use of nonstatin medications only. METHODS: We performed a retrospective analysis of 118 patients referred to our tertiary care centre for management of SAMS, defined as development of muscle-related symptoms with 2 or more statins. Baseline and last follow-up lipid parameters were documented. Patients were classified as tolerant of a strategy if, at their last follow-up, they remained on that strategy. RESULTS: After a median follow-up of 17 months, most (n = 79; 67%) patients were able to tolerate a statin. Tolerability was similar among the 3 treatment strategies (71% same-statin rechallenge vs 53% statin switch vs 57% for nonstatin therapy only; P = 0.11). Those in the same-statin rechallenge and statin switch groups achieved greater LDL-C reductions compared with those who only tolerated nonstatins (-38.8 ± 3.4% vs -36.4 ± 2.9% vs -17.3 ± 4.5%; P = 0.0007). A greater proportion of patients in the same-statin rechallenge group achieved their target LDL-C compared with those in the nonstatin therapy only group (50% vs 15%; odds ratio, 6.8; 95% confidence interval, 1.5-40.7; P = 0.04). CONCLUSIONS: Among individuals with a history of SAMS, most will tolerate statin therapy. Same-statin rechallenge was highly tolerable and efficacious. Thus, same-statin rechallenge might warrant increased utilization. SN - 1916-7075 UR - https://www.unboundmedicine.com/medline/citation/28449837/Management_Strategies_for_Statin_Associated_Muscle_Symptoms:_How_Useful_Is_Same_Statin_Rechallenge L2 - https://linkinghub.elsevier.com/retrieve/pii/S0828-282X(17)30078-8 DB - PRIME DP - Unbound Medicine ER -