Current Diabetes Reports

, Volume 13, Issue 3, pp 381–390 | Cite as

Do Statins Cause Diabetes?

  • Mark R. GoldsteinEmail author
  • Luca Mascitelli
Macrovascular Complications in Diabetes (PD Reaven, Section Editor)


A wealth of evidence has established that cholesterol-lowering statin drugs, widely used for the prevention of cardiovascular disease, do increase the risk of new-onset diabetes, possibly by impairing pancreatic beta cell function and decreasing peripheral insulin sensitivity. Groups at particular risk include the elderly, women, and Asians. The diabetogenic effect of statins appear directly related to statin dose and the degree of attained cholesterol lowering. Statins can cause hyperinsulinemia even in the absence of hyperglycemia and the potential mitogenic effects and implications of prolonged hyperinsulinemia are discussed. Suggestions are made as to how physicians might avert the hyperinsulinemic and diabetogenic effects of statin therapy in clinical practice, and modulate the detrimental effects of these drugs on exercise performance. Finally, long-term studies are needed to determine if the deleterious hyperinsulinemic and diabetogenic effects of statin therapy undermine the beneficial cardiovascular disease risk outcomes in various segments of the population.


Statins Diabetes Prediabetes Hyperinsulinemia Insulin resistance Mitochondrial dysfunction Cancer 


Conflict of Interest

Mark R. Goldstein declares that he has no conflict of interest.

Luca Mascitelli declares that he has no conflict of interest.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Gotto AM, Moon JE. Management of cardiovascular risk: the importance of meeting lipid targets. Am J Cardiol. 2012;110(Suppl):3A–14A.PubMedCrossRefGoogle Scholar
  2. 2.
    Metz SA, Rabaglia ME, Stock JB, Kowluru A. Modulation of insulin secretion from normal rat islets by inhibitors of the post-translational modifications of GTP-binding proteins. Biochem J. 1993;295:31–40.PubMedGoogle Scholar
  3. 3.
    Ohrvall M, Lithell H, Johansson J, Vessby B. A comparison between the effects of gemfibrozil and simvastatin on insulin sensitivity in patients with noninsulin dependent diabetes mellitus and hyperlipoproteinemia. Metabolism. 1995;44:212–7.PubMedCrossRefGoogle Scholar
  4. 4.
    Ridker PM, Danielson E, Fonseca FAH, Genest J, Gotto AM, Kastelein JJP, et al. For the JUPITER Study Group. N Engl J Med. 2008;359:2195–207.Google Scholar
  5. 5.
    Ridker PM, Pradhan A, MacFadyen JG, Libby P, Glynn RJ. Cardiovascular benefits and diabetes risks of statin therapy in primary prevention: an analysis from the JUPITER trial. Lancet. 2012;380:565–71.PubMedCrossRefGoogle Scholar
  6. 6.
    Steinberg D. Earlier intervention in the management of hypercholesterolemia: what are we waiting for? J Am Coll Cardiol. 2010;56:627–9.PubMedCrossRefGoogle Scholar
  7. 7.
    Pletcher MJ, Hulley SB. Statin therapy in young adults: ready for prime time? J Am Coll Cardiol. 2010;56:637–40.PubMedCrossRefGoogle Scholar
  8. 8.
    Petersen LK, Christensen K, Kragstrup J. Lipid-lowering treatment to the end? A review of observational studies and RCTs on cholesterol and mortality in 80+-year olds. Age Aging. 2010;39:674–80.CrossRefGoogle Scholar
  9. 9.
    Simons LA, Simons J, Friedlander Y, McCallum J. Predictors of long-term mortality in the elderly: the Dubbo Study. Intern Med J. 2011;41:555–60.PubMedCrossRefGoogle Scholar
  10. 10.
    Carter BL, Einhorn PT, Brands M, He J, Cutler JA, Whelton PK, et al. Thiazide-induced dysglycemia: call for research from a working group from the National Heart, Lung, and Blood Pressure Institute. Hypertension. 2008;52:30–6.Google Scholar
  11. 11.
    Goldberg RB, Jacabson TA. Effects of niacin on glucose control in patients with dyslipidemia. Mayo Clin Proc. 2008;83:470–8.PubMedCrossRefGoogle Scholar
  12. 12.
    Cooper-DeHoff RM, Pacanowski MA, Pepine CJ. Cardiovascular therapies and associated glucose homeostasis: implications across the dysglycemia continuum. J Am Coll Cardiol. 2009;53:S28–34.PubMedCrossRefGoogle Scholar
  13. 13.
    Nolan CJ, Damm P, Prentki M. Type 2 diabetes across generations: from pathophysiology to prevention and management. Lancet. 2011;378:169–81.PubMedCrossRefGoogle Scholar
  14. 14.
    Mascitelli L, Goldstein MR. Long-standing statin therapy and the risk of new-onset diabetes in the elderly: collateral damage caused by preventive medicine? Drugs Aging. 2010;29:9–13.CrossRefGoogle Scholar
  15. 15.
    •• Campbell PT, Jacobs EJ, Newton CC, Gapstur SM, Patel AV. Diabetes and cause-specific mortality in a prospective cohort of one million U.S. adults. Diabetes Care. 2012;35:1835–44. This very large 26-year observational study shows that diabetes is associated with an increased mortality from a variety of cancers in both men and women.PubMedCrossRefGoogle Scholar
  16. 16.
    Barone BB, Yeh H-C, Snyder CF, Peairs KS, Stein KB, Derr RL, et al. Long-term all-cause mortality in cancer patients with preexisting diabetes mellitus: a systematic review and meta-analysis. JAMA. 2008;300:2754–64.Google Scholar
  17. 17.
    Freeman DJ, Norrie J, Sattar N, Neely DG, Cobbe SM, Ford I, et al. Pravastatin and the development of diabetes mellitus: evidence for a protective treatment effect in the West of Scotland Coronary Prevention Study. Circulation. 2001;103:357–62.Google Scholar
  18. 18.
    Keech A, Hague W, Colquhoun D, Beller E, Best J, Arulchelvam M, et al. For the LIPID Study Group. Secondary prevention of cardiovascular events with long-term pravastatin in patients with diabetes or impaired fasting glucose: results from the LIPID trial. Diabetes Care. 2003;26:2713–21.Google Scholar
  19. 19.
    Shepherd J, Blauw MB, Murphy MB, Bollen ELEM, Buckley BM, Cobbe SM, et al. On behalf of the PROSPER Study Group. Pravastatin in elderly individuals at risk of vascular disease (PROSPER): a randomized controlled trial. Lancet. 2002;360:1623–30.Google Scholar
  20. 20.
    Sattar N, Preiss D, Murray HM, Welsh P, Buckley BM, de Craen AJM, et al. Statins and risk of incident diabetes: a collaborative meta-analysis of randomized statin trials. Lancet. 2010;375:735–42.Google Scholar
  21. 21.
    •• Mora S, Glynn RJ, Hsia J, MacFadyen JG, Genest J, Ridker PM. Statins for the primary prevention of cardiovascular events in women with elevated high-sensitivity C-reactive protein or dyslipidemia: results from the Justification for the Use of Statins in Prevention: an Intervention Trial Evaluating Rosuvastatin (JUPITER) and meta-analysis of women from primary prevention trials. Circulation. 2010;121:1069–77. This post-hoc analysis of the JUPITER trial is notable for the women in the rosuvastatin group exhibiting a significant absolute increase in new-onset diabetes equal to the absolute decrease in the composite primary endpoint of cardiovascular disease events.Google Scholar
  22. 22.
    Fugh-Berman A. Rosuvastatin in patients with elevated C-reactive protein. N Engl J Med. 2009;360:1038–9.PubMedCrossRefGoogle Scholar
  23. 23.
    Liao JK. Safety and efficacy of statins in Asians. Am J Cardiol. 2007;99:410–4.PubMedCrossRefGoogle Scholar
  24. 24.
    Chan JCN, Malik V, Jia W, Kadowaki T, Yajnik CS, Yoon K-H, et al. Diabetes in Asia: epidemiology, risk factors, and pathophysiology. JAMA. 2009;301:2129–40.Google Scholar
  25. 25.
    Culver AL, Ockene IS, Balasubramanian R, Olendzki BC, Sepavich DM, Wactawski-Wende J, et al. Statin use and risk of diabetes mellitus in postmenopausal women in the Woman’s Health Initiative. Arch Intern Med. 2012;172:144–52.Google Scholar
  26. 26.
    Zaharan NL, Williams D, Bennet K. Statins and risk of treated incident diabetes in a primary care population. Br J Clin Pharmacol. 2012. [Epub ahead of print].Google Scholar
  27. 27.
    Rajpathak SN, Barzilai N, Kumbhani DJ, Alderman M, Crandall J, Ridker PM. Statin therapy and risk of developing type 2 diabetes: a meta-analysis. Diabetes Care. 2009;32:1924–9.Google Scholar
  28. 28.
    • Preiss D, Seshasai SRK, Welsh P, Murphy SA, Ho JE, Waters DD, et al. Risk of incident diabetes with intensive-dose compared with moderate-dose statin therapy; a meta-analysis. JAMA. 2011;305:2556–64. This large meta-analysis shows that intensive compared with moderate-dose statin therapy is associated with a significantly greater risk of new-onset diabetes.Google Scholar
  29. 29.
    Koh KK, Quon MJ, Han SH, Lee Y, Kim SJ, Park JB, et al. Differential metabolic effects of pravastatin and simvastatin in hypercholesterolemic patients. Atherosclerosis. 2009;204:483–90.Google Scholar
  30. 30.
    Koh KK, Quon MJ, Han SH, Lee Y, Kim SJ, Shin EK. Atorvastatin causes insulin resistance and increases ambient glycaemia in hypercholesterolemic patients. J Am Coll Cardiol. 2010;55:1209–16.Google Scholar
  31. 31.
    •• Moutzouri E, Liberopoulos E, Mikhailidis DP, Kostapanos MS, Kei AA, Milionis H, et al. Comparison of the effects of simvastatin vs rosuvastatin vs simvastatin/ezetimibe on parameters of insulin resistance. Int J Clin Pract. 2011;65:1141–8. This study demonstrates that statin therapy can significantly increase fasting insulin levels without having an effect on fasting glucose or glycosylated hemoglobin levels.Google Scholar
  32. 32.
    Koh KK, Ahn JY, Quon MJ, Kim SJ, Han SH, Koh Y, et al. Simvastatin improves flow-mediated dilation but reduces adiponectin levels and insulin sensitivity in hypercholesterolemic patients. Diabetes Care. 2008;31:776–82.Google Scholar
  33. 33.
    Meier JJ. Beta cell mass in diabetes: a realistic therapeutic target? Diabetologia. 2008;51:701–13.CrossRefGoogle Scholar
  34. 34.
    Defronzo RA, Tripathy D. Skeletal muscle insulin resistance is the primary defect in type 2 diabetes. Diabetes Care. 2009;32:S157–63.PubMedCrossRefGoogle Scholar
  35. 35.
    Xia F, Xie L, Mihic A, Gao X, Chen Y, Gaisano HY, et al. Inhibition of cholesterol biosynthesis impairs insulin secretion and voltage-gated calcium channel function in pancreatic β-cells. Endocrinology. 2008;149:5136–45.Google Scholar
  36. 36.
    • Brown JE. The ageing pancreas. Br J Diabetes Vasc Dis. 2012;12:141–5. This interesting paper notes that the aging pancreas is associated with impaired beta cell function, implies that the elderly might be particularly sensitive to statin induced beta cell dysfunction.CrossRefGoogle Scholar
  37. 37.
    •• Kwak H-B, Thalacker-Mercer A, Anderson EJ, Lin C-T, Kane DA, Lee N-S, et al. Simvastatin impairs ADP-stimulated respiration and increases mitochondrial oxidative stress in primary human skeletal myotubes. Free Radic Biol Med. 2012;52:198–207. This paper shows how simvastatin results in skeletal muscle mitochondrial dysfunction.Google Scholar
  38. 38.
    Galtier F, Mura T, de Mauverger ER, Chevassus H, Farret A, Gagnol J-P, et al. Effect of high dose of simvastatin on muscle mitochondrial metabolism and calcium signaling in healthy volunteers. Toxicol Appl Pharmacol. 2012;263:281–6.Google Scholar
  39. 39.
    • Hoeks J, Schrauwen P. Muscle mitochondria and insulin resistance: a human perspective. Trends Endocrinol Metab. 2012;23:444–50. This interesting paper connects skeletal muscle mitochondrial dysfunction with insulin resistance.PubMedCrossRefGoogle Scholar
  40. 40.
    Kusminski CM, Scherer PE. Mitochondrial dysfunction in white adipose tissue. Trends Endocrinol Metab. 2012;23:435–43.PubMedCrossRefGoogle Scholar
  41. 41.
    • Supale S, Li N, Brun T, Maechler P. Mitochondrial dysfunction in pancreatic β cells. Trends Endocrinol Metab. 2012;23:477–87. This paper suggests pancreatic beta cell mitochondrial dysfunction leads to beta cell apoptosis and cell death.PubMedCrossRefGoogle Scholar
  42. 42.
    Chamberlain LH. Inhibition of isoprenoid biosynthesis causes insulin resistance in 3T3-L1 adipocytes. FEBS Lett. 2001;507:357–61.PubMedCrossRefGoogle Scholar
  43. 43.
    Nakata M, Nagasaka S, Kusaka I, Matsuoka H, Ishibashi S, Yada T. Effects of statins on the adipocyte maturation and expression of glucose transporter 4 (SLC2A4): implications in glycemic control. Diabetologia. 2006;49:1881–92.Google Scholar
  44. 44.
    Shepherd PR, Kahn BB. Glucose transporters and insulin action: implications for insulin resistance and diabetes mellitus. N Engl J Med. 1999;341:248–57.PubMedCrossRefGoogle Scholar
  45. 45.
    Chidlow Jr JH, Sessa WC. Caveolae, caveolins, and cavins; complex control of cellular signaling and inflammation. Cardiovasc Res. 2010;86:219–25.PubMedCrossRefGoogle Scholar
  46. 46.
    Breen MR, Camps M, Carvalho-Simoes F, Zorzano A, Pilch PF. Cholesterol depletion in adipocytes causes caveolae collapse concomitant with proteosomal degradation of cavin-2 in a switch-like fashion. PLoS One. 2012;7:e34516.Google Scholar
  47. 47.
    González-Muñoz E, López-Iglesias C, Calvo M, Palacin M, Zorzano A, Camps M. Caveolin-1 loss of function accelerates glucose transporter 4 and insulin receptor degradation in 3T3-L1 adipocytes. Endocrinology. 2009;150:3493–502.Google Scholar
  48. 48.
    Abel ED, Peroni O, Kim JK, Kim YB, Boss O, Hadro E, et al. Adipose-selective targeting of the GLUT4 gene impairs insulin action in muscle and liver. Nature. 2001;409:729–33.Google Scholar
  49. 49.
    • Rosenbaum D, Dallongeville J, Sabouret P, Bruckert E. Discontinuation of statin therapy due to muscular side effects: a survey in real life. Nutr Metab Cardiovasc Dis. 2012. [Epub ahead of print]. This important study shows that muscular side effects from average doses of statins in real-life clinical situations are much more common than what has been seen in clinical trials. Google Scholar
  50. 50.
    Fernandez G, Spatz ES, Jablecki C, Phillips PS. Statin myopathy: a common dilemma not reflected in clinical trials. Cleve Clin J Med. 2011;78:393–403.PubMedCrossRefGoogle Scholar
  51. 51.
    Draeger A, Monastyrskaya K, Mohaupt M, Hoppeler H, Savolainen H, Allemann C, et al. Statin therapy induces ultrastructural damage in skeletal muscle in patients without myalgia. J Pathol. 2006;210:94–102.Google Scholar
  52. 52.
    Golomb BA, Evans MA, Dimsdale JE, White HL. Effects of statins on energy and fatigue with exertion: results from a randomized controlled trial. Arch Intern Med. 2012;172:1180–2.PubMedGoogle Scholar
  53. 53.
    Scott D, Blizzard L, Fell J, Jones G. The epidemiology of sarcopenia in community living older adults: what role does lifestyle play? J Cachex Sarcopenia Muscle. 2011;2:125–34.CrossRefGoogle Scholar
  54. 54.
    Khamseh ME, Malek M, Aghili R, Emami Z. Sarcopenia and diabetes: pathogenesis and consequences. Br J Diabetes Vasc Dis. 2011;11:230–4.CrossRefGoogle Scholar
  55. 55.
    •• Zhou XH, Qiao Q, Zethelius B, Pyörälä K, Söderberg S, Pajak A, et al, for the DECODE Study Group. Diabetes, prediabetes and cancer mortality. Diabetologia. 2010;53:1867–76. This large observational study shows that pre-diabetes and diabetes are risk factors for cancer mortality in men and women irrespective of body mass index.Google Scholar
  56. 56.
    Noto H, Tsujimoto T, Noda M. Significantly increased risk of cancer in diabetes mellitus patients: a meta-analysis of epidemiological evidence in Asians and non-Asians. J Diabetes Invest. 2012;3:24–33.CrossRefGoogle Scholar
  57. 57.
    Tsugane S, Inoue M. Insulin resistance and cancer: epidemiological evidence. Cancer Sci. 2010;101:1073–9.PubMedCrossRefGoogle Scholar
  58. 58.
    Johnson JA, Pollak M. Insulin, glucose and the increased risk of cancer in patients with type 2 diabetes. Diabetologia. 2010;53:2086–8.PubMedCrossRefGoogle Scholar
  59. 59.
    Cowie CC, Williams DE, Rust KF, Gregg EW, Ford ES, Bainbridge KE, et al. Full accounting of diabetes and pre-diabetes in the U.S. population in 1988-1994 and 2005–2006. Diabetes Care. 2009;32:287–94.Google Scholar
  60. 60.
    Simard EP, Ward EM, Siegel R, Jemal A. Cancers with increasing incidence trends in the United States: 1999 through 2008. CA Cancer J Clin. 2012;62:118–28.CrossRefGoogle Scholar
  61. 61.
    DeSantis C, Siegel R, Bandi P, Jemal A. Breast cancer statistics, 2011. CA Cancer J Clin. 2011;61:409–18.PubMedCrossRefGoogle Scholar
  62. 62.
    Gallagher EJ, LeRoith D. Mini-review: IGF, insulin, and cancer. Endocrinology. 2011;152:2546–51.PubMedCrossRefGoogle Scholar
  63. 63.
    • Pollak M. The insulin and insulin-like growth factor family in neoplasia: an update. Nat Rev Cancer. 2012;12:159–69. This is a great review on the mechanisms of hyperinsulinemia and insulin growth factor signaling in oncogenesis.PubMedGoogle Scholar
  64. 64.
    Giovannucci E, Habel LA, Harlan DM, Pollak M, Archer MC, Regensteiner JG, et al. Diabetes and cancer: a consensus report. Diabetes Care. 2010;33:1674–85.Google Scholar
  65. 65.
    Wanders D, Plaisance EP, Judd RL. Pharmacological effects of lipid-lowering drugs on circulating adipokines. World J Diabetes. 2010;1:116–28.PubMedCrossRefGoogle Scholar
  66. 66.
    Jardé T, Perrier S, Vasson M-P, Caldefie-Chézet F. Molecular mechanisms of leptin and adiponectin in breast cancer. Eur J Cancer. 2011;47:33–43.PubMedCrossRefGoogle Scholar
  67. 67.
    Kelesidis I, Kelesidis T, Mantzoros CS. Adiponectin and cancer: a systematic review. Br J Cancer. 2006;94:1221–5.PubMedCrossRefGoogle Scholar
  68. 68.
    Duggan C, Irwin ML, Xiao L, Henderson KD, Smith AW, Baumgartner RN, et al. Associations of insulin resistance and adiponectin with mortality in women with breast cancer. J Clin Oncol. 2011;29:32–9.Google Scholar
  69. 69.
    Goldstein MR, Mascitelli L. Statin-induced diabetes: perhaps, it’s the tip of the iceberg. Q J Med. 2011;104:174–8.CrossRefGoogle Scholar
  70. 70.
    Udagawa T. Tumor dormancy of primary and secondary cancers. APMIS. 2008;116:615–28.PubMedCrossRefGoogle Scholar
  71. 71.
    • Sniderman A, Thanassoulis G, Couture P, Williams K, Alam A, Furberg CD. Is lower and lower better and better? A re-evaluation of the evidence from the Cholesterol Treatment Trialists’ Collaboration meta-analysis for low-density lipoprotein lowering. J Clin Lipidol. 2012;6:303–9. This paper challenges the dogma that achieving ultra-low cholesterol levels with maximal doses of statins yields significantly better clinical results.Google Scholar
  72. 72.
    Ferenczi EA, Asaria P, Hughes AD, Chaturvedi N, Francis DP. Can a statin neutralize the cardiovascular risk of unhealthy dietary choices? Am J Cardiol. 2010;106:587–92.PubMedCrossRefGoogle Scholar
  73. 73.
    Mizuno K, Tajima Y, Ohashi Y, Nakamura H. Is the risk of new-onset diabetes by statins associated with diet adherence? Int J Cardiol. 2012. [Epub ahead of print].Google Scholar
  74. 74.
    Perreault L, Pan Q, Mather KJ, Watson KE, Hamman RF, Kahn SE, for the Diabetes Prevention Program Research Group. Effect of regression from prediabetes to normal glucose regulation on long-term reduction in diabetes risk: results from the Diabetes Prevention Program Outcomes Study. Lancet. 2012;379:2243–51.Google Scholar
  75. 75.
    Jula A, Marniemi J, Huupponen R, Virtanen A, Rastas M, Rönnemaa T. Effects of diet and simvastatin on serum lipids, insulin, and antioxidants in hypercholesterolemic men: a randomized controlled trial. JAMA. 2002;287:598–605.Google Scholar
  76. 76.
    Caprio S. Calories from soft drinks—do they matter? N Engl J Med. 2012;367:1462–3.PubMedCrossRefGoogle Scholar
  77. 77.
    Qi Q, Chu AY, Kang JH, Jensen MK, Curhan GC, Pasquale LR, et al. Sugar-sweetened beverages and genetic risk of obesity. N Engl J Med. 2012;367:1387–96.Google Scholar
  78. 78.
    Tappy L, Lê K-A. Metabolic effects of fructose and the worldwide increase in obesity. Physiol Rev. 2010;90:23–46.PubMedCrossRefGoogle Scholar
  79. 79.
    Port AM, Ruth MR, Istfan NW. Fructose comsumption and cancer: is there a connection? Curr Opin Endocrinol Diabetes Obes. 2012;19:367–74.PubMedGoogle Scholar
  80. 80.
    Pomeranz JL, Brownell KB. Portion sizes and beyond—Government’s legal authority to regulate food industry practices. N Engl J Med. 2012;367:1383–5.PubMedCrossRefGoogle Scholar
  81. 81.
    Roden M. Exercise in type 2 diabetes: to resist or to endure? Diabetologia. 2012;55:1235–9.PubMedCrossRefGoogle Scholar
  82. 82.
    Lira VA, Benton CR, Yan Z, Bonen A. PGC-1α regulation by exercise training and its influences on muscle function and insulin sensitivity. Am J Physiol Endocrinol Metab. 2010;299:E145–61.PubMedGoogle Scholar
  83. 83.
    • Grontved A, Rimm EB, Willett WC, Anderson LB, Hu FB. A prospective study of weight training and risk of type 2 diabetes mellitus in men. Arch Intern Med. 2012;172:1306–12. This paper suggests that combined resistance and endurance exercise provide the best results in decreasing the risk of diabetes.PubMedGoogle Scholar
  84. 84.
    Parker BA, Thompson PD. Effect of statins on skeletal muscle: exercise, myopathy, and muscle outcomes. Exerc Sport Sci Rev. 2012;40:188–94.PubMedGoogle Scholar
  85. 85.
    Deichmann R, Lavie C, Andrews S. Coenzyme Q10 and statin-induced mitochondrial dysfunction. Ochsner J. 2010;10:16–21.PubMedGoogle Scholar
  86. 86.
    Binkley N, Ramamurthy R, Krueger D. Low vitamin D status: definition, prevalence, consequences, and correction. Endocrinol Metab Clin N Am. 2010;39:287–301.CrossRefGoogle Scholar
  87. 87.
    Borges MC, Martini LA, Rogero MM. Current perspectives on vitamin D, immune system, and chronic diseases. Nutrition. 2011;27:399–404.PubMedCrossRefGoogle Scholar
  88. 88.
    Alvarez JA, Ashraf A. Role of vitamin D in insulin secretion and insulin sensitivity for glucose homeostasis. Int J Endocrinol. 2010;2010:351385.PubMedGoogle Scholar
  89. 89.
    Ahmed W, Khan N, Glueck CJ, Pandey S, Wang P, Goldenberg N, et al. Low serum 25(OH) vitamin D levels (<32 ng/mL) are associated with reversible myositis-myalgia in statin-treated patients. Transl Res. 2009;153:11–6.Google Scholar
  90. 90.
    Booth FW, Hargreaves M. Understanding multi-organ pathology from insufficient exercise. J Appl Physiol. 2011;111:1199–200.PubMedCrossRefGoogle Scholar
  91. 91.
    Thyfault JP, Krogh-Madsen R. Metabolic disruptions induced by reduced ambulatory activity in free-living humans. J Appl Physiol. 2011;111:1218–24.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  1. 1.NCH Healthcare GroupNaplesUSA
  2. 2.Comando Brigata Alpina “Julia”, Medical ServiceUdineItaly

Personalised recommendations