Statin-associated myopathy and the quest for biomarkers: can we effectively predict statin-associated muscle symptoms?
Abstract
Over the past three decades, statins have become the cornerstone of prevention and treatment of atherosclerotic cardiovascular and metabolic diseases. Albeit generally well tolerated, these drugs can elicit a variety of muscle-associated symptoms that represent the most important reason for treatment discontinuation. Statin-associated myopathy has been systematically underestimated by randomized controlled trials as compared with the incidence observed in clinical practice and obtained from patient registries. There are several reasons for this discrepancy, among which the lack of reliable diagnostic tests and a validated questionnaire to assess muscle symptoms are recognized as unmet needs. Here, we review the cellular and molecular mechanisms underlying statin-associated myopathy and discuss the experimental and clinical data on various biomarkers to diagnose and predict muscle-related complaints.
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These muscle effects might be relevant for SAMS patients, especially combined with potent LDL-lowering nutraceuticals.
“All of these effects, along with the respective mechanistic bases (e.g., effect on muscle fibers and mitochondrial biogenesis), might be relevant for SAMS patients, especially in the combination with nutraceuticals with potent LDL-lowering action (178,179).”
From The Role of Nutraceuticals in Statin Intolerant Patients (2018) · cites this paper as [178]
HMB, beta-alanine, and carnosine are known to improve muscle mass, function, hypertrophy, lean mass, aerobic performance, exercise capacity, and muscle protein synthesis, and to reduce muscle damage, protein breakdown, and fatigue.
“Besides the nutraceuticals with LDL-lowering properties, it is worth mentioning those, such as b-hydroxy b-methylbutyric acid, b-alanine, and carnosine, that are known to improve muscle mass, muscle function, hypertrophy, lean body mass, aerobic performance and exercise capacity, and muscle protein synthesis, as well as to decrease muscle damage and muscle protein breakdown and fatigue (178,179).”
From The Role of Nutraceuticals in Statin Intolerant Patients (2018) · cites this paper as [178]
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Diagnostik und Therapie von statinassoziierten Muskelsymptomen
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Bartłomiejczyk, M. A., Penson, P. E., & Banach, M. (2020) · Contemporary cardiology · doi:10.1007/978-3-030-33304-1_14 · Cited by 4 · see citing works
Assessment of bee venom therapy in animal model of statin-induced myopathy
Kader, A. A., Azmy, R. M., Maher, E. A., Sayed, B. B. E., Khalil, A. S., Ghalwash, M., & Mahmoud, M. M. (2019) · The Egyptian Journal of Neurology Psychiatry and Neurosurgery · doi:10.1186/s41983-019-0120-9 · Cited by 4 · see citing works
Rationale for the use of metformin and exercise to counteract statin‐associated side effects
Haxhi, J., & Thompson, P. D. (2020) · International Journal of Clinical Practice · doi:10.1111/ijcp.13900 · Cited by 4 · see citing works
Weninger, G., Dridi, H., Reiken, S. R., Yuan, Q., Zhao, N., Groom, L. A., Leigh, J., Liu, Y., Tchagou, C., Kang, J., et al. (2025) · Journal of Clinical Investigation · doi:10.1172/jci194490 · Cited by 3 · see citing works
Cao, W., Li, L., Mathur, P., Thompson, J., & Milks, M. W. (2023) · BMC Medical Informatics and Decision Making · doi:10.1186/s12911-023-02221-4 · Cited by 3 · see citing works
Molecular Mechanisms Affecting Statin Pharmacokinetics after Bariatric Surgery
Petrinović, M., Majetić, D., Bakula, M., Pećin, I., Vitković, D. F., Deškin, M., Perković, D. T., Bakula, M., Gradišer, M., Bilić-Čurčić, I., et al. (2024) · International Journal of Molecular Sciences · doi:10.3390/ijms251910375 · Cited by 3 · see citing works
Guo, X., Xu, J., Lu, X., Zheng, X., Chen, X., Sun, Z., Shen, B., Tang, H., Duan, Y., Zhou, Z., et al. (2024) · Advanced Healthcare Materials · doi:10.1002/adhm.202400254 · Cited by 2 · see citing works
Genetic Biomarkers for Statin-Induced Myopathy
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Fabiś, J., Danilewicz, M., Niedzielski, K. R., Waszczykowski, M., Fabiś-Strobin, A., & Bogucki, A. (2021) · Archives of Medical Science · doi:10.5114/aoms/131956 · Cited by 2 · see citing works
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Future of Statins in Sepsis: A Review on Its Safety and Efficacy
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Management of Statin Intolerance
Bartłomiejczyk, M. A., Penson, P. E., & Banach, M. (2020) · Contemporary cardiology · doi:10.1007/978-3-030-56514-5_12 · Cited by 1 · see citing works
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Some molecular mechanisms of the statin-associated myopathy development
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The insidious impact of under-diagnosed proximal weakness induced by statins
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Histological Study for the Effect of Squalene Supplements on Muscles Rats Treated with Simvastatin
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Urine Proteome Changes in a Simvastatin-Induced Skeletal Muscle Injury Rat Model
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Cao, W., Li, L., Mathur, P., Thompson, J., & Milks, M. W. (2024) · Figshare · doi:10.6084/m9.figshare.26605300
Huang, J., Fan, Z., & Ding, Y. (2026) · Journal of Clinical Pharmacy and Therapeutics · doi:10.1155/jcpt/3306258
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- Authors
- Muntean, D. M., Thompson, P. D., Catapano, A. L., Stasiolek, M., Fabis, J., Muntner, P., Serban, M.-C., & Banach, M.
- Affiliations
- Victor Babeș University of Medicine and Pharmacy Timișoara (RO)
- Hartford Hospital (US)
- University of Milan (IT)
- University of Alabama at Birmingham (US)
- Medical University of Lodz (PL)
- Corresponding author
- Banach, Maciej
- Venue
- Drug Discovery Today
- Publisher
- Elsevier BV
- Published
- 2017-01
- Volume
- 22
- Issue
- 1
- Pages
- 85-96
- ISSN
- 1359-6446 (ISSN-L)
- OpenAlex
- W2519430929
- Cited by
- 82
- References
- 135
- Citations by year
- 2026: 2 · 2025: 6 · 2024: 8 · 2023: 10 · 2022: 6 · 2021: 7 · 2020: 14 · 2019: 10 · 2018: 9 · 2017: 8 · 2016: 2
- FWCI
- 1.92
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Drug Discovery Today (publishedVersion)
- PubMed (publishedVersion)
- Funders
- University of Lodz
- Topics
- Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Muscle Physiology and Disorders
- Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Toxicology › Pharmacovigilance and Adverse Drug Reactions
- Keywords
- statin-induced myopathy, statins, muscle symptoms, biomarkers, drug-induced myopathy, treatment discontinuation, atherosclerotic cardiovascular disease, metabolic disorders, diagnostic testing, molecular mechanisms, patient registry
- MeSH terms
- Animals, Drug Interactions, Humans, Muscular Diseases, Predictive Value of Tests, Risk Factors, Biomarkers, Hydroxymethylglutaryl-CoA Reductase Inhibitors
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