ReviewCurrent overview of statin-induced myopathy
Section snippets
Statin-induced muscular adverse events
The terminology to describe muscle toxicity is not consistent. For example, myopathy has been defined as muscle pain, tenderness, or weakness associated with abnormal elevations in creatine kinase levels (>10 times the upper limit of normal) (14), whereas the American College of Cardiology/American Heart Association/National Heart, Lung, and Blood Institute (ACC/AHA/NHLBI) task force considers myopathy to be a general term for disease of the muscles (11). The incidence of dose-dependent
Factors influencing the myotoxic potential of statins
The low risk of myotoxicity with statin therapy may be increased by factors that predispose the patient to myopathy, such as age, sex, and body size, or increase in the concentration of statin in muscle tissue (Table 2) 11, 36. Many of these risk factors are increasing in prevalence. For example, the likelihood of living longer, and the effect of aging on muscles, coupled with the increased possibility of comorbid conditions or use of concomitant medications, can increase the risk of myotoxic
Combined lipid-lowering therapy: a special case of polypharmacy
Despite the efficacy of statin therapy, patients with severe hypercholesterolemia may require additional lipid-lowering therapy to reduce LDL cholesterol levels further and to achieve the goals recommended by the National Cholesterol Education Program (64). If necessary, a bile acid sequestrant or cholesterol absorption inhibitor (ezetimibe) may be used in combination with a statin to reduce LDL cholesterol levels further, whereas addition of a fibrate or niacin may be considered in patients
Benefit-risk ratio and the choice of statin
The small risk of myopathy does not outweigh the benefits of statins for reducing cardiovascular morbidity and mortality. Moreover, the benefit-risk ratio of statin therapy is favorable compared with other well-established therapies. For example, fibrates are less efficacious in reducing LDL cholesterol levels (77) and have been associated with a greater risk of myopathy (6.6 events/10,000 person-years vs. 1.2 events/10,000 person-years for statins) (31).
Despite differences in statin
Conclusion
The efficacy of statins for lipid lowering and reducing the risk of coronary heart disease is well established. Although statins are generally well tolerated, a small proportion of patients may develop myopathy. The incidence of severe statin-induced myopathy is low and does not outweigh the benefits of risk reduction of coronary events. Due to the increasing prevalence of metabolic syndrome and type 2 diabetes, the use of combination lipid-modifying therapies, such as statin-fibrate or
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