Evidence-Based Management of Statin Myopathy
First Online: 14 July 2010 DOI:
Cite this article as: Harper, C.R. & Jacobson, T.A. Curr Atheroscler Rep (2010) 12: 322. doi:10.1007/s11883-010-0120-9 Abstract
Statin-associated muscle symptoms are a relatively common condition that may affect 10% to 15% of statin users. Statin myopathy includes a wide spectrum of clinical conditions, ranging from mild myalgia to rhabdomyolysis. The etiology of myopathy is multifactorial. Recent studies suggest that statins may cause myopathy by depleting isoprenoids and interfering with intracellular calcium signaling. Certain patient and drug characteristics increase risk for statin myopathy, including higher statin doses, statin cytochrome metabolism, and polypharmacy. Genetic risk factors have been identified, including a single nucleotide polymorphism of
SLCO1B1. Coenzyme Q10 and vitamin D have been used to prevent and treat statin myopathy; however, clinical trial evidence demonstrating their efficacy is limited. Statin-intolerant patients may be successfully treated with either low-dose statins, alternate-day dosing, or using twice-weekly dosing with longer half-life statins. An algorithm is presented to assist the clinician in managing myopathy in patients with dyslipidemia. Keywords Myalgia Myopathy Muscle symptoms Statin Fibrates Drug safety Rhabdomyolysis Algorithm Drug interactions Myositis Coenzyme Q 10 Red yeast rice Creatine kinase Cholesterol Management Lipids Vitamin D Cytochrome metabolism Ezetimibe Colesevelam References Papers of particular interest, published recently, have been highlighted as: •• Of major importance
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