Statin Myopathy: A Lipid Clinic Experience on the Tolerability of Statin Rechallenge
Abstract
Introduction Statin myopathy is a generally encountered side effect of statin usage. Both muscle symptoms and a raised serum creatine kinase (CK) are used in case definition, but these are common manifestations of other conditions, which may not be statin related. Statin rechallenge assuming no contraindication in selected cases is an option before considering a different class of lipid-lowering agent. Aims We aim to characterize retrospectively the patients referred to our Lipid Clinic with a diagnosis of statin myopathy. The tolerability of different statins was assessed to determine a strategy for rechallenging statins in such patients in the future. Results Patients with statin myopathy constitute 10.2% of our Lipid Clinic workload. They are predominantly female (62.0%), Caucasian (63.9%), with a mean age of 58.3 years and mean body mass index (BMI) of 29.3 kg/m(2). The serum CK and erythrocyte sedimentation rate (ESR) were statistically higher compared to patients with statin intolerances with no muscular component or CK elevations. Secondary causes of statin myopathy were implicated in 2.7% of cases. Following statin myopathy to simvastatin we found no statistical difference between the tolerability rates between atorvastatin, rosuvastatin, pravastatin, and fluvastatin. Fibrates, cholestyramine, and ezetimibe were statistically better tolerated in these patients. Conclusions Statin rechallenge is a real treatment option in patients with statin myopathy. Detailed history…
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All 8 identified retrospective studies were of low quality, mainly due to concerns regarding residual confounding because of lack of adjustment.
“Notably all 8 identified retrospective studies were of low quality, mainly due to concerns regarding residual confounding because of lack of adjustment (S2 File) [35,36,38,41,42,44,45,50].”
A different study reported lower incidence of muscle symptoms when comparing statin-based treatment with fibrates, bile sequestrant or omega-3 fatty acids.
“On the other hand, a different study reported lower incidence of muscle symptoms was reported when comparing statin-based treatment with fibrates, bile sequestrant or omega-3 fatty acids [38].”
We included eight retrospective cohort studies and two prospective cohort studies.
“We included eight retrospective cohort studies [35,38,39,41,42,44,45,50] and two cohort prospective studies [36,37] (S4 File, Table 2).”
Three studies reported the incidence of muscle symptoms, five studies provided data on treatment discontinuation due to muscle symptoms, and eight studies reported on effectiveness.
“Three studies reported the incidence of muscle symptoms [36–38], five studies provided data on treatment discontinuation due to muscle symptoms [36,37,39,42,45], and eight studies reported on effectiveness [35–37,39,41,44,45,50].”
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Safety considerations with fibrate therapy
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Effect of coenzyme Q10 supplementation on simvastatin-induced myalgia
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Myopathy with statin–fibrate combination therapy: clinical considerations
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Phenotype standardization for statin-induced myotoxicity
Alfirevic, A., Neely, D., Armitage, J., Chinoy, H., Cooper, R. G., Laaksonen, R., Carr, D. F., Bloch, K. M., Fahy, J., Hanson, A., et al. (2014) · Clinical Pharmacology & Therapeutics · doi:10.1038/clpt.2014.121 · Cited by 220 · see citing works
Mancini, G. B. J., Tashakkor, A. Y., Baker, S., Bergeron, J., Fitchett, D., Frohlich, J., Genest, J., Gupta, M., Hegele, R. A., Ng, D. S., et al. (2013) · Canadian Journal of Cardiology · doi:10.1016/j.cjca.2013.09.023 · Cited by 173 · see citing works
Aebi, P. S., Villoz, F., Bührer, J., Lyko, C., Abolhassani, N., Del Giovane, C., Gencer, B., Rodondi, N., & Blum, M. R. (2025) · PLOS One · doi:10.1371/journal.pone.0338575
“Notably all 8 identified retrospective studies were of low quality, mainly due to concerns regarding residual confounding because of lack of adjustment (S2 File) [35,36,38,41,42,44,45,50].”
Influential
- Authors
- Fung, E. C., & Crook, M. A.
- Affiliations
- University Hospital Lewisham (GB)
- Corresponding author
- Fung, En C.
- ORCID
- Crook, Martin A.
- Venue
- Cardiovascular Therapeutics
- Publisher
- Wiley
- Published
- 2011-04
- Volume
- 30
- Issue
- 5
- Pages
- e212-8
- ISSN
- 1755-5914 (ISSN-L)
- 1755-5922
- OpenAlex
- W1484225384
- Cited by
- 34
- References
- 5
- Citations by year
- 2024: 1 · 2022: 1 · 2021: 2 · 2020: 1 · 2019: 1 · 2018: 2 · 2017: 2 · 2016: 9 · 2015: 2 · 2014: 7 · 2013: 4 · 2012: 1
- FWCI
- 4.25
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Cardiovascular Therapeutics (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Cancer Research › Cancer, Lipids, and Metabolism
- Health Sciences › Medicine › Pharmacology › Drug-Induced Adverse Reactions
- Keywords
- statin-induced myopathy, statin rechallenge, statin intolerance, simvastatin, rosuvastatin, pravastatin, fluvastatin, atorvastatin, creatine kinase elevation, muscle symptoms, lipid-lowering drugs, fibrates, ezetimibe, cholestyramine, tolerability
- MeSH terms
- Adult, Aged, Anticholesteremic Agents, Creatine Kinase, Female, Humans, Male, Middle Aged, Muscular Diseases, Retrospective Studies, Risk Factors, Sex Factors, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Simvastatin, Lipid Metabolism
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