Significance of Statin-Associated Muscle Symptoms and Its Impact on Patients Adherence and Outcomes

Abstract

Statin-associated muscle symptoms (SAMS) are one of the most common side effects of statins. This study aimed to explore the significance of SAMS among statin users by comparing statin users with a control group. To achieve our aims, a propensity score matching the retrospective cohort study was conducted in a single center tertiary hospital. The statin muscle symptoms were assessed using the Proposed Statin Myalgia Index Score, whereas the patient's adherence to medications was evaluated using the Morisky Medication Adherence Scale-8. We included 743 patients in our study; of them, 64.9% were on statin, whereas the rest were controls (35.1%). After propensity score matching, patients on statin had significantly higher rates of SAMS (5.0%) compared with control (1.6%) (AOR = 3.209; 95% CI: 1.020-10.091). However, there was no significant difference between statin users and controls in medications nonadherence (P-value = 0.820). Our analysis among statins users revealed that moderate-intensity (2.671; 95% CI: 1.691-3.310) and high-intensity (3.552; 95% CI: 2.190-4.129) statin therapy was significantly associated with SAMS. In addition, autoimmune diseases were significantly associated with SAMS occurrence (AOR = 32.301; 95% CI: 1.785-584.374). Also, patients on PPIs had significantly less occurrence of SAMS (AOR = 0.145; 95% CI: 0.044-0.483), whereas patients on antiepileptic drugs had significantly higher SAMS occurrence (AOR = 72.337; 95% CI: 2.649-1975.201). Regarding MACE among statin users, there was no significant difference in the 1-year or 5-year MACE rate between statin users and controls. Our study suggests that SAMS are significant among statin users and must be addressed by health care providers to ensure that patients are still adherent to their medications and hence protected against cardiac events.

A Jordanian Multidisciplinary Consensus Statement on the Management of Dyslipidemia

“…However, statin-associated muscle symptoms (SAMS) are still one of the most prevalent statin adverse events, especially in those on moderate- or high-intensity therapy. Furthermore, individuals who have autoimmune diseases and those who are on antiepileptic medications were found to have significantly higher rates of SAMS [ 84 ]. Therefore, healthcare providers must be aware of these adverse events and address them appropriately to ascertain the adherence of patients to their prescribed medications, thus reducing cardiovascular events.…”

The Significance of Statin-Associated Muscle Symptoms and Its Impact on Patient Adherence and Outcomes

“…6 However, further studies are needed to better clarify the association between risk factors and SAMS. In fact, Al-Makhamreh et al, 7 in their observational retrospective cohort study, did not confirm gender, and both kidney and hepatic impairment association with an increased risk of SAMS onset, giving more prominence instead to the presence of autoimmune diseases. Moreover, a recent metanalysis pointed out that statin therapy causes approximately 11 additional reports of any muscle pain or weakness per 1000 patients during the first year, with only a little increase thereafter, with some evidence of persistent risk for more intensive regimens.…”

“…Of these, some patients complained that they were not properly informed about side effects before starting statin treatment. 8 Al-Makhamreh et al, 7 in their recent article, have reported a non–statistically significant difference between patients experiencing SAMS and the control group. This finding might be due to the improvement in doctor–patient relationship, to patient involvement in assessing and managing adverse effects, which rarely represent a life-threatening condition (myopathy incidence is ∼1 in 10,000 per year; rhabdomyolysis incidence ∼1 in 100,000 per year), and to the increase in patient knowledge about the risk–benefit ratio of statin therapy use and discontinuation.…”

“…This finding might be due to the improvement in doctor–patient relationship, to patient involvement in assessing and managing adverse effects, which rarely represent a life-threatening condition (myopathy incidence is ∼1 in 10,000 per year; rhabdomyolysis incidence ∼1 in 100,000 per year), and to the increase in patient knowledge about the risk–benefit ratio of statin therapy use and discontinuation. 6,7…”

“…In fact, lack of adherence among statin and control groups were 28.9% and 28.0%, respectively. 7 In this scenario, it becomes clear that clinicians can still do a lot to improve patient adherence. It has been pointed out that inquiring about medication-taking behavior, developing a trusting relationship, improving continuity of care, understanding the role of family support, identifying nonsupportive family member behaviors, understanding patient's financial situation, and suggesting the best treatment for all budgets could represent a good path on the way to patient adherence improvement.…”