Statin induced myopathy

Sathasivam, Sivakumar; Lecky, Bryan

doi:10.1136/bmj.a2286

Cited by 149 publications

(112 citation statements)

References 27 publications

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“…Should the symptoms return strong presumptive evidence exists that the symptoms are truly statin-related. Although it has been reported that statin-related symptoms can be present for months after the drug is discontinued, this is unusual and suggests that an underlying independent muscle disorder should be excluded [24,199,200].…”

Section: The Most Common Diagnostic Errorsmentioning

confidence: 83%

“…Many factors come into play such as cost, potential side effects, and the stigma of having to take medication over an indefinite period [199,200]. Fueling the so-called statin rebellion is the unfiltered information on the internet, interpretation of TV advertisements, and exhaustive small print package inserts warning of every conceivable side effect.…”

Section: The Most Common Diagnostic Errorsmentioning

confidence: 99%

“…Muscle symptoms that appear only after a few days is more unusual for statin-related symptoms as true statin-related symptoms most commonly appear weeks to months after initiation of therapy or increase in dose (75% in the first 12 weeks) and are more common in patients on high dose therapy and/or who are also taking other medication [19]. Muscle symptoms that begin after years of statin usage without a medication change are less likely to be statin-related [200]. A useful approach is to fulfill a modification of so-called Koch's Postulates [24], and remove the statin for 2-3(4) weeks.…”

Section: The Most Common Diagnostic Errorsmentioning

confidence: 99%

See 2 more Smart Citations

Statin intolerance – an attempt at a unified definition. Position paper from an International Lipid Expert Panel

Banach

Rizzo²,

Tóth

et al. 2015

Expert Opinion on Drug Safety

182

204

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Section: The Most Common Diagnostic Errorsmentioning

confidence: 83%

Section: The Most Common Diagnostic Errorsmentioning

confidence: 99%

Section: The Most Common Diagnostic Errorsmentioning

confidence: 99%

See 1 more Smart Citation

Statin intolerance – an attempt at a unified definition. Position paper from an International Lipid Expert Panel

Banach

Rizzo²,

Tóth

et al. 2015

Expert Opinion on Drug Safety

182

204

View full text Add to dashboard Cite

“…5 Notably, the estimated incidence of true statin-induced myopathy, characterized by muscle weakness with concomitant elevation in CK, is much lower, at 44 to 120 per million per year. 6,7 Anti-HMGCR NAM is even more rare, with an incidence estimated to be 2 per million per year. 5 Marked elevation in CK is characteristic of NAM, with a mean value of 10,000 IU/L compared to the self-limited form.…”

Section: Discussionmentioning

confidence: 99%

“…5 The mechanism of myocyte disruption in self-limited statin myopathy is not fully understood, but theories include changes in the cholesterol composition of cellular membranes, effects on compounds such as coenzyme Q10 that require cholesterol precursors for synthesis, and decreased isoprenoids responsible for reducing apoptosis of myocytes. 7 In general, statins produce a self-limited myopathy that resolves within several months of medication cessation; however, they are also associated with increased incidence of inflammatory myopathies including DM and PM as well as statin-associated NAM. 8,9 Similar to self-limited statin myopathy, statin-associated NAM pathophysiology is poorly understood.…”

Section: Discussionmentioning

confidence: 99%

An Unusual Case of Statin-Induced Myopathy: Anti-HMGCoA Necrotizing Autoimmune Myopathy

et al. 2015

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Statins are some of the most widely prescribed medications, and though generally well tolerated, can lead to a self-limited myopathy in a minority of patients. Recently, these medications have been associated with a necrotizing autoimmune myopathy (NAM). Statin-associated NAM is characterized by irritable myopathy on electromyography (EMG) and muscle necrosis with minimal inflammation on muscle biopsy. The case presented is a 63-yearold woman who has continued elevation of creatine kinase (CK) after discontinuation of statin therapy. She has irritable myopathy on EMG and NAM is confirmed by muscle biopsy. She subsequently tests positive for an experimental anti-3-hydroxy-3-methylglutaryl-coenzyme A (antiHMGCoA) antibody that is found to be present in patients with statin-associated NAM. Though statin-associated NAM is a relatively rare entity, it is an important consideration for the general internist in patients who continue to have CK elevation and weakness after discontinuation of statin therapy. Continued research is necessary to better define statin-specific and dose-dependent risk, as well as optimal treatment for this condition.KEY WORDS: statin; anti-HMGCR antibody; necrotizing autoimmune myopathy; idiopathic inflammatory myopathy.

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Statins’ effect on plasma levels of Coenzyme Q10 and improvement in myopathy with supplementation

Littlefield

Beckstrand

Luthy

2014

Journal of the American Association of Nurse Practitioners

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PurposeHeart disease is the leading cause of death in the United States. HMG‐CoA reductase inhibitors, or statins, are medications at the forefront of the battle against cardiovascular disease. Despite their effectiveness, patient compliance with statins has lagged because of medication cost and adverse effects, namely myopathy. Myopathy is the most common side effect of statin use. The purpose of this review is to report plasma levels of CoQ10 in patients taking statins and then to determine the benefit of Coenzyme Q10 (CoQ10) supplementation on statin‐related myopathy as evidenced by symptomatic improvement and increase in serum levels of CoQ10. Data sourcesCINAHL, Medline, Health Source: Nursing/Academic Edition, and Cochrane Library. ConclusionsEvidence from this review suggests that studies showed a significant relationship between statin intake and decreased serum levels of CoQ10. A few studies showed a benefit in symptoms of myalgia or improvement of serum levels of CoQ10 with supplementation. One study showed no benefit of CoQ10 supplementation when taken with statins. There were no risks of supplementation reported in any of the studies. Implications for PracticeCoQ10 supplementation might benefit those patients suffering from statin‐induced myopathy as evidenced by the results of these studies. Supplementation of CoQ10 at a dose of between 30 and 200 mg daily has shown to have beneficial effects on statin myopathy with no noted side effects. Further research is necessary.

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Statin induced myopathy

Cited by 149 publications

References 27 publications

Statin intolerance – an attempt at a unified definition. Position paper from an International Lipid Expert Panel

Statin intolerance – an attempt at a unified definition. Position paper from an International Lipid Expert Panel

An Unusual Case of Statin-Induced Myopathy: Anti-HMGCoA Necrotizing Autoimmune Myopathy

Statins’ effect on plasma levels of Coenzyme Q10 and improvement in myopathy with supplementation

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