Statin-induced myopathy: a case report

Cock, Emmanuel De; Hannon, Heidi; Moerman, Veronique; Schurgers, Marie

doi:10.1093/ehjcr/yty130

Cited by 3 publications

(9 citation statements)

References 13 publications

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“…10 Muscle biopsy in these cases uniquely features muscle necrosis with myofiber regeneration and minimal inflammation. 11 Although this patient's CPK levels decreased, they were not substantial, and his symptoms paradoxically worsened. As a result of this presentation, SINAM remained high on the differential.…”

Section: Rheumatology Service Commentarymentioning

confidence: 79%

“…SINAM is differentiated from statin-associated myopathy alone by the presence of HMGCR antibodies, the degree of CPK elevation, the preference for proximal muscle involvement, and the incomplete resolution of symptoms on cessation of statin therapy 10 . Muscle biopsy in these cases uniquely features muscle necrosis with myofiber regeneration and minimal inflammation 11 . Although this patient’s CPK levels decreased, they were not substantial, and his symptoms paradoxically worsened.…”

Section: Case Reportmentioning

confidence: 80%

“…Their use is projected to increase even further because of the excellent evidence demonstrating efficacy in primary and secondary prevention of cardiovascular disease. 11 Although the use of statins has cardiovascular benefits, their use is limited by their adverse effect profile. Statin-induced myopathy has a spectrum of phenotypes that include statin-induced myalgia, in which muscle pain is not associated with increased CPK levels; statin-induced myositis, in which muscle pain is related to an increase in CPK; statin-induced rhabdomyolysis, with a marked rise in CPK levels; and SINAM, which presents with necrosis without inflammation.…”

Section: Commentarymentioning

confidence: 99%

“…16 Muscle biopsy in these cases uniquely features muscle necrosis with myofiber regeneration and minimal inflammation. 11 Statin intolerance may occur at any time after commencing treatment. The immune-mediated effects of statin therapy on muscle fibers may be sustained long after statin cessation through persistently elevated HMGCR expression in regenerating muscle fibers.…”

Section: Commentarymentioning

confidence: 99%

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When Statins Get Physical: A Curious Cause of Statin Myopathy

Patel¹,

Jackson²

2022

Southern Medical Journal

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We present the case of a 61-year-old male with hyperlipidemia and lumbar radiculopathy admitted to our hospital with rhabdomyolysis attributed to the recent initiation of statin therapy. Despite aggressive fluid resuscitation and an initial declination in his creatine phosphokinase (CPK) levels, he had persistent myalgias with progressive weakness. Rheumatologic and neurologic evaluation for other causes of myopathy were negative. Muscle biopsy obtained showed signs of necrosis and muscle regeneration. Given his recent statin use, persistent CPK elevation, proximal muscle weakness, and muscle biopsy findings, he was diagnosed as having statin-induced necrotizing autoimmune myopathy. He improved with the initiation of immunosuppressive therapy. Statininduced necrotizing autoimmune myopathy is an underdiagnosed cause of myalgias, proximal muscle weakness, and significant CPK elevation that fails to respond to statin discontinuation and fluid resuscitation. Given the prevalence of statin use, internists need to have a high index of suspicion for this diagnosis in patients presenting with CPK elevations and muscle weakness who take statin therapy.

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Section: Rheumatology Service Commentarymentioning

confidence: 79%

Section: Case Reportmentioning

confidence: 80%

Section: Commentarymentioning

confidence: 99%

Section: Commentarymentioning

confidence: 99%

See 2 more Smart Citations

When Statins Get Physical: A Curious Cause of Statin Myopathy

Patel¹,

Jackson²

2022

Southern Medical Journal

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“…Immune-mediated features, such as endothelial membrane attack complex (MAC) deposition in non-necrotic fibers and MHC class I expression, are additional pathogenic features of this condition [ 68 , 69 ].…”

Section: Statins and Autoimmune Illnessesmentioning

confidence: 99%

Statins Neuromuscular Adverse Effects

Attardo

Musumeci

Velardo

et al. 2022

IJMS

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Statins are drugs widely prescribed in high-risk patients for cerebrovascular or cardiovascular diseases and are, usually, safe and well tolerated. However, these drugs sometimes may cause neuromuscular side effects that represent about two-third of all adverse events. Muscle-related adverse events include cramps, myalgia, weakness, immune-mediated necrotizing myopathy and, more rarely, rhabdomyolysis. Moreover, they may lead to peripheral neuropathy and induce or unmask a preexisting neuromuscular junction dysfunction. A clinical follow up of patients assuming statins could reveal early side effects that may cause neuromuscular damage and suggest how to better modulate their use. In fact, statin dechallenge or cessation, or the alternative use of other lipid-lowering agents, can avoid adverse events. This review summarizes the current knowledge on statin-associated neuromuscular adverse effects, diagnosis, and management. It is conceivable that the incidence of neuromuscular complications will increase because, nowadays, use of statins is even more diffused than in the past. On this purpose, it is expected that pharmacogenomic and environmental studies will help to timely predict neuromuscular complications due to statin exposure, leading to a more personalized therapeutic approach.

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Correlates of Myopathy in Diabetic Patients Taking Statins

Tariq¹,

Goriparthi²,

Ismail³

et al. 2023

Cureus

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Diabetes is one of the most common chronic ailments; its incidence has reached epidemic proportions in the 21st century. Diabetes significantly increases micro and macrovascular complications, which are effectively managed with statins. Therefore, statins' pharmacokinetics, pharmacodynamics, and pharmacogenetics have been extensively studied. Although statins act as a keystone in preventing cardiovascular complications, at the same time, they pose a threat to the quality of life of diabetics due to the resulting muscular side effects. This article summarizes the prevalence, clinical manifestations, pathophysiology, and risk factors of statin-induced myopathy in diabetic patients. Among the diverse predisposing risk factors, the primary variables identified for causing myopathy in diabetic patients include age, gender, ethnicity, duration and severity of illness, comorbid conditions, level of physical activity, alcohol use, cholecalciferol (vitamin D3) levels, type and dose of statins, and anti-diabetic drugs or other drugs used concomitantly. In addition, cardiovascular risk quotients also potentially impact diabetic patients making them more vulnerable to developing myopathy from statins. Therefore, this study highlights the importance of managing statin-associated myopathic side effects by providing consensus guidelines on diagnostic, monitoring, and treatment strategies. We also discussed statins' prognostic value in reducing cardiovascular events in diabetic individuals.

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Statin-induced myopathy: a case report

Cited by 3 publications

References 13 publications

When Statins Get Physical: A Curious Cause of Statin Myopathy

When Statins Get Physical: A Curious Cause of Statin Myopathy

Statins Neuromuscular Adverse Effects

Correlates of Myopathy in Diabetic Patients Taking Statins

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