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

By E. Stroes, P. Thompson, A. Corsini, G. Vladutiu, F. Raal, K. Ray, M. Roden, Evan Stein, L. Tokgözoğlu, Børge G. Nordestgaard and 23 more. European Heart Journal, 2015

1,260 citations recorded by the source corpus.

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.

Subfields: Cardiology and Cardiovascular Medicine, Epidemiology, Surgery

View Paper: https://www.semanticscholar.org/paper/17955d33daf4f7b0c36788ae813999f13542cc17

How researchers see this paper

The researchers whose trusted networks rank it highest, strongest advocate first. Every researcher gets a different order.

In Cardiology and Cardiovascular Medicine

1. Rhian M. Touyz
2. Marja-Riitta Taskinen
3. I. Graham
4. T. Ivanova
5. Gerhard Hindricks
6. Stephan Windecker

In Epidemiology

1. Lina Badimon
2. I. Graham
3. Diederick E. Grobbee
4. Alberico L. Catapano
5. Rhian M. Touyz
6. Stephan Windecker

In Surgery

1. I. Graham
2. Marja-Riitta Taskinen
3. T. Ivanova
4. Alberico L. Catapano
5. Ulrich Laufs

Citations in the corpus

• Severe Rhabdomyolysis due to Presumed Drug Interactions between Atorvastatin with Amlodipine and Ticagrelor (2017, background): ““Rhabdomyolysis is a severe formofmuscle damage associated with very high creatinine kinase (CK) levels, with myoglobinaemia and/or myoglobinuria with a concomitantly increased risk of renal failure” [4].”
• 2016 European Guidelines on cardiovascular disease prevention in clinical practice (2017, neutral): “In practice, management of a patient with myalgia but without a major creatinine kinase increase is based on trial and error and usually involves a trial of a different statin or the use of a very low dosage several days a week with a gradual increase [376].”
• 2019 ESC/EAS guidelines for the management of dyslipidaemias: Lipid modification to reduce cardiovascular risk. (2019, background): “In rhabdomyolysis, creatine kinase (CK) levels are elevated by >_10 times, and often >_40 times, the upper limit of normal (ULN).(234) The frequency of rhabdomyolysis has been estimated to represent 1 3 cases/100 000 patient-years.”
• 2016 European Guidelines on cardiovascular disease prevention in clinical practice (2016, background): “In practice, management of a patient with myalgia but without a major creatinine kinase increase is based on trial and error and usually involves a trial of a different statin or the use of a very low dosage several days a week with a gradual increase.(376)”
• 2016 European Guidelines on cardiovascular disease prevention in clinical practice. (2016, background): “In practice, management of a patient with myalgia but without a major creatinine kinase increase is based on trial and error and usually involves a trial of a different statin or the use of a very low dosage several days a week with a gradual increase.(376)”