European Journal of Clinical Pharmacology

, Volume 74, Issue 9, pp 1099–1109 | Cite as

A comprehensive review and meta-analysis of risk factors for statin-induced myopathy

  • Khoa A. NguyenEmail author
  • Lang Li
  • Deshun Lu
  • Aida Yazdanparast
  • Lei Wang
  • Rolf P. Kreutz
  • Elizabeth C. Whipple
  • Titus K. Schleyer



To aid prescribers in assessing a patient’s risk for statin-induced myopathy (SIM), we performed a comprehensive review of currently known risk factors and calculated aggregated odds ratios for each risk factor through a meta-analysis.


This meta-analysis was done through four phases: (1) Identification of the relevant primary literature; (2) abstract screening using inclusion and exclusion criteria; (3) detailed review and data extraction; and (4) synthesis and statistical analysis.


Out of 44 papers analyzed from 836 papers searched from MEDLINE, 18 different potential risk factors were collected, divided into three categories: three demographics (11 papers), ten clinical factors (31 papers), and five pharmacogenetics/biomarkers (12 papers). Risk factors significant for myopathy and/or rhabdomyolysis included age, gender, diabetes, renal impairment, cardiovascular disease, certain interacting drugs, and mutations of the SLCO1B1 gene, which encodes a transporter protein in the liver. Several factors, such as gender, race, cardiovascular disease, and the GATM gene, which encodes a protein for creatine synthesis, appeared to be protective in terms of the outcomes of interest.


This comprehensive assessment of risk factors can help support clinicians in reducing the incidence of SIM in their patient population on statins.


Statins Risks Risk factors Comprehensive review Myotoxicity Statin-induced myopathy 



This work was made possible by the support of Clem MacDonald chair account and by Lilly Endowment Inc. Physician Scientist Initiative. We gratefully acknowledge Lane Coffee’s help with manuscript preparation, and Sandy Poremba’s and Lisa Gill’s in preparing the bibliography.

Funding information

This work was further supported by VA HSR&D grant CIN 13-416 at the Richard L. Roudebush Veterans Affairs Medical Center in Indianapolis, Indiana.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest.

Supplementary material

228_2018_2482_MOESM1_ESM.docx (1002 kb)
ESM 1 (DOCX 1001 kb)


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Copyright information

© This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply 2018

Authors and Affiliations

  • Khoa A. Nguyen
    • 1
    • 2
    Email author
  • Lang Li
    • 3
  • Deshun Lu
    • 4
  • Aida Yazdanparast
    • 5
  • Lei Wang
    • 3
  • Rolf P. Kreutz
    • 6
  • Elizabeth C. Whipple
    • 7
  • Titus K. Schleyer
    • 8
    • 9
  1. 1.Center for Health Information and Communication, Department of Veterans Affairs (VA), Veterans Health Administration, Health Service Research and Development Service (CIN 13-416)Richard L. Roudebush VA Medical CenterIndianapolisUSA
  2. 2.Department of Pharmacy Practice, College of PharmacyPurdue UniversityIndianapolisUSA
  3. 3.Department of Biomedical Informatics, College of MedicineThe Ohio State UniversityColumbusUSA
  4. 4.Division of Clinical Pharmacology, Department of MedicineIndiana University School of MedicineIndianapolisUSA
  5. 5.Center for Computational Biology and BioinformaticsIndiana University School of MedicineIndianapolisUSA
  6. 6.Department of Medicine, Krannert Institute of CardiologyIndiana University School of MedicineIndianapolisUSA
  7. 7.Research and Translational SciencesIndiana University School of MedicineIndianapolisUSA
  8. 8.Department of MedicineIndiana University School of MedicineIndianapolisUSA
  9. 9.Center for Biomedical InformaticsRegenstrief InstituteIndianapolisUSA

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