An assessment by the Statin Muscle Safety Task Force: 2014 update

Abstract

The National Lipid Association's Muscle Safety Expert Panel was charged with the duty of examining the definitions for statin-associated muscle adverse events, development of a clinical index to assess myalgia, and the use of diagnostic neuromuscular studies to investigate muscle adverse events. We provide guidance as to when a patient should be considered for referral to neuromuscular specialists and indications for the performance of a skeletal muscle biopsy. Based on this review of evidence, we developed an algorithm for the evaluation and treatment of patients who may be intolerant to statins as the result of adverse muscle events. The panel was composed of clinical cardiologists, clinical lipidologists, an exercise physiologist, and a neuromuscular specialist.

Insights Into Statin Intolerance

“…The panel was in agreement that the Figure 1, as recently published in the Journal of Clinical Lipidology ,4 is representative of an appropriate algorithmic approach.…”

Lipids, blood pressure and kidney update 2014

“…The National Lipid Association's Muscle Safety Expert Panel proposed a myalgia clinical index score [40]. Taking all these into account, it seems, that definition of statin intolerancethe inability to tolerate a dose of statin required reducing a person's CV risk sufficiently -is the easiest to understand not only by the specialists but especially by general practitioners.…”

Statin myopathy: navigating the maze

“…This diagnosis becomes even more difficult since the muscle reported symptoms are subjective, there is no "gold standard" diagnostic test nor a universally approved risk score in order to evaluate the presence of SAMS. Different expert panels have proposed various definitions as well as classifications of SAMS [9][10][11][12] .…”

“…The National Lipid Association's Muscle Safety Expert Panel proposed muscle adverse events to be defined as: (i) "myalgia" (muscle pain), (ii) "myopathy" (muscle weakness), (iii) "myositis" (muscle inflammation as determined by skeletal muscle biopsy and/or magnetic resonance imaging), (iv) "myonecrosis" (muscle injury based on the magnitude of serum creatine kinase [CK] elevation in comparison to the patient's pre-statin CK level or an arbitrary normative upper limit adjusted for age, race, and sex), and (v) "myonecrosis with myoglobinuria or acute renal failure" or "clinical rhabdomyolysis" (increase in serum creatinine 0.5 mg/dL) 11 . Moreover, this expert panel recommended a statin myalgia clinical index score based on the distribution of muscle complaints, temporal pattern of onset and improvement after statin withdrawal, and recurrence on rechallenge 11 .…”

“…Moreover, this expert panel recommended a statin myalgia clinical index score based on the distribution of muscle complaints, temporal pattern of onset and improvement after statin withdrawal, and recurrence on rechallenge 11 . The European Atherosclerosis Society (EAS) Consensus Panel suggested that assessment should be based on the presence of muscle symptoms as well as CK levels 12 .…”