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Lipid-lowering Therapies in Myositis

  • Inflammatory Muscle Disease (L Diederichsen and H Chinoy, Section Editors)
  • Published:
Current Rheumatology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

The use of lipid-lowering therapies in patients with idiopathic inflammatory myopathies (IIM) is complicated and there are no guidelines for diagnosing, monitoring, or treating atherosclerotic cardiovascular disease (ASCVD) in this group of patients.

Recent Findings

The use of lipid-lowering therapies, especially statins, is recommended in patients with increased risk for ASCVD, which includes patients with inflammatory diseases, based on recent American College of Cardiology/American Heart Association (ACC/AHA) guidelines for ASCVD management.

Summary

There is accumulating evidence that patients with IIM are at increased risk for ASCVD, similar to other inflammatory diseases. Lipid-lowering therapies have side effects that may be pronounced or confounding in myositis patients, potentially limiting their use. Statins are specifically contraindicated in patients with anti 3-hydroxy-3-methylglutaryl-CoA reductase (HMGCR) antibodies. Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors have been shown to be safe and potentially beneficial in patients with IIM. Here, we propose a framework for (1) ASCVD risk assessment and treatment based on ACC/AHA ASCVD primary prevention guidelines; (2) myositis disease monitoring while undergoing lipid-lowering therapy; and (3) management of statin intolerance, including, indications for the use of PCSK9 inhibitors.

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Notes

  1. The Charlson Comorbidity Index (CCI) is a validated predictor of increased risk for 1-year mortality [55], based on a weighted composite score for the presence of diagnosis in the following categories: cardiovascular, endocrine, pulmonary, neurologic, renal, hepatic, gastrointestinal, and neoplastic diseases. Higher CCI scores are associated with higher comorbidity.

  2. The SAMS-CI is an instrument developed by the National Lipid Association to assess the likelihood that muscle symptoms are attributable to statin use. It incorporates information about muscle symptom patterns, location, and chronology with respect to statin use, including response to statin de-challenge and re-challenge [90]. The SAMS-CI has been validated for use in the general population with sensitivity 85.7% and specificity 76.3% for SAMS [91].

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Funding

MCM was supported by NIH Grant Number T32-AR048522. ET was supported by the Jerome L Greene Foundation.

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  1. Department of Medicine, Division of Rheumatology, Mason Lord, Center Tower, Johns Hopkins University School of Medicine, 5200 Eastern Avenue, Baltimore, MD, 21224, USA

    Marisa C. Mizus & Eleni Tiniakou

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Mizus, M.C., Tiniakou, E. Lipid-lowering Therapies in Myositis. Curr Rheumatol Rep 22, 70 (2020). https://doi.org/10.1007/s11926-020-00942-3

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