Low vitamin D does not predict statin associated muscle symptoms but is associated with transient increases in muscle damage and pain

Abstract

Background and aims Low vitamin D (VITD) may contribute to statin-associated muscle symptoms (SAMS). We examined the influence of baseline and change in VITD in patients with verified SAMS. Methods SAMS was verified in 120 patients with prior statin muscle complaints using 8-week randomized, double-blind crossover trials of simvastatin (SIMVA) 20 mg/d and placebo. 25 (OH)vitamin D was measured at each phase of the trial. Results Forty-three patients (35.8%) experienced muscle pain on SIMVA but not placebo, exhibiting confirmed SAMS. VITD (mean ± standard deviation) prior to SIMVA treatment were not different between patients who did (31.7 ± 12.1 ng/mL, n=43) or did not (31.6 ± 10.3 ng/mL, n=77) develop SAMS and did not predict SAMS (p=0.96). The change in VITD with SIMVA treatment was not different between patients with and without SAMS (0.3 ± 5.9 vs. 0.2±8.3 ng/mL, respectively) and did not predict SAMS (p=0.96). The proportion of patients classified as VITD deficient (<20 ng/mL) did not differ between patients with (n=16) and without (n=10) SAMS (χ2=1.45; p=0.23), nor did the proportion of patients classified as VITD insufficient (<30 ng/mL) (n=42 vs. 48; χ2<0.01 and p=0.94). Both baseline and on-statin VITD were inversely related to the change in creatine kinase (CK) with statin therapy (p=0.01 and 0.02, respectively), independent of SAMS (p=0.36 and 0.35). Conclusions Baseline VITD, VITD deficiency/insufficiency and changes in VITD with statin therapy do not predict SAMS in patients with rigorously verified SAMS. However, low VITD may exacerbate statin-induced muscle injury and could contribute to SAMS development with a longer duration of statin treatment.

Decrease in Serum Vitamin D Level of Older Patients with Fatigue

“…In fact, both are associated with a range of lifestyle-related features, including low educational attainment, smoking, and physical inactivity [50,51,52]. In this context, it is worth mentioning that exercise-induced tissue damage and lipid peroxidation have been significantly lowered by vitamin D treatment in severely deficient human subjects [53]. Finally, the low serum levels of vitamin D have been associated with high fatigue severity in older subjects [54].…”

Statin-Associated Muscle Disease: Advances in Diagnosis and Management

“…Vitamin D supplementation may mitigate muscle symptoms [65,66], although this is not a consistent finding [67][68][69]. In our CoQ10 in Statin Myopathy Trial, we found no relationship between vitamin D levels, pre-and post-statin therapy, or clinical vitamin D deficiency and insufficiency, on the development of SAMS [70]. Nonetheless, vitamin D repletion when appropriate is recommended given the overall importance of vitamin D for muscle function.…”

Relationship Between Statin-associated Muscle Symptoms, Serum Vitamin D and Low-density Lipoprotein Cholesterol – A Cross-sectional Study

“…Taylor et al also found that vitamin D deficiency or insufficiency and changes in vitamin D levels during statin therapy did not predict the occurrence of SAMS. 20 As the current study was conducted in India, and many Indian people have insufficient levels of vitamin D, we converted their levels into percentiles, which revealed that the chance of occurrence of SAMS was significantly increased in those with vitamin D levels less than or equal to the 5th, 10th and 25th percentiles. This association was not significant at a percentile cut-off level of 50, which corresponds to vitamin D levels of ≥20.12 ng/mL.…”