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Eur Heart J. 2015 May 1;36(17):1012-22. doi: 10.1093/eurheartj/ehv043. Epub 2015 Feb 18.

Statin-associated muscle symptoms: impact on statin therapy-European Atherosclerosis Society Consensus Panel Statement on Assessment, Aetiology and Management.

Author information

1
Department of Vascular Medicine, Academic Medical Center, Amsterdam, The Netherlands e.s.stroes@amc.uva.nl.
2
Hartford Hospital, Hartford, CT, USA.
3
University of Milan and Multimedica IRCSS Milano, Italy.
4
School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY, USA.
5
University of the Witwatersrand, Johannesburg, South Africa.
6
St. Georges's University of London, UK.
7
Department of Endocrinology and Diabetology, University Hospital Düsseldorf Heinrich-Heine University, and Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research, Germany.
8
Metabolic and Atherosclerosis Research Centre, Cincinnati, OH, USA.
9
Hacettepe University, Ankara, Turkey.
10
Herlev Hospital, Copenhagen University Hospital, University of Copenhagen, Denmark.
11
Pitié-Salpetriere University Hospital, Paris, France.
12
Ghent University, Ghent, Belgium.
13
Children's Hospital Oakland Research Institute, Oakland, CA, USA.
14
Universitätsklinikum des Saarlandes, Homburg/Saar, Germany.
15
University of Sao Paulo, Brazil.
16
Western University, London, ON, Canada.
17
Academic Medical Center, University of Amsterdam, The Netherlands.
18
Li Ka Shing Knowledge Institute and Keenan Research Centre for Biomedical Science, St. Michael's Hospital, University of Toronto, Canada.
19
Cardiology Service, HUG, Geneva, Switzerland.
20
Synlab Center of Laboratory Diagnostics Heidelberg, Heidelberg, Germany.
21
New York University School of Medicine, New York, USA.
22
Sahlgrenska University Hospital, Gothenburg, Sweden.
23
Emory University School of Medicine, Atlanta, GA, USA.
24
INSERM, Pitié-Salpetriere University Hospital, Paris, France.

Abstract

Statin-associated muscle symptoms (SAMS) are one of the principal reasons for statin non-adherence and/or discontinuation, contributing to adverse cardiovascular outcomes. This European Atherosclerosis Society (EAS) Consensus Panel overviews current understanding of the pathophysiology of statin-associated myopathy, and provides guidance for diagnosis and management of SAMS. Statin-associated myopathy, with significant elevation of serum creatine kinase (CK), is a rare but serious side effect of statins, affecting 1 per 1000 to 1 per 10 000 people on standard statin doses. Statin-associated muscle symptoms cover a broader range of clinical presentations, usually with normal or minimally elevated CK levels, with a prevalence of 7-29% in registries and observational studies. Preclinical studies show that statins decrease mitochondrial function, attenuate energy production, and alter muscle protein degradation, thereby providing a potential link between statins and muscle symptoms; controlled mechanistic and genetic studies in humans are necessary to further understanding. The Panel proposes to identify SAMS by symptoms typical of statin myalgia (i.e. muscle pain or aching) and their temporal association with discontinuation and response to repetitive statin re-challenge. In people with SAMS, the Panel recommends the use of a maximally tolerated statin dose combined with non-statin lipid-lowering therapies to attain recommended low-density lipoprotein cholesterol targets. The Panel recommends a structured work-up to identify individuals with clinically relevant SAMS generally to at least three different statins, so that they can be offered therapeutic regimens to satisfactorily address their cardiovascular risk. Further research into the underlying pathophysiological mechanisms may offer future therapeutic potential.

KEYWORDS:

Cholesterol; Consensus statement; Lipids; Mitochondrial; Muscle symptoms; Myalgia; Myopathy; Statin; Statin intolerance

PMID:
25694464
PMCID:
PMC4416140
DOI:
10.1093/eurheartj/ehv043
[Indexed for MEDLINE]
Free PMC Article

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