Effects of simvastatin 40 mg daily on muscle and liver adverse effects in a 5-year randomized placebo-controlled trial in 20,536 high-risk people.
BACKGROUND
Simvastatin reduces cardiovascular mortality and morbidity but, as with other HMG-CoA reductase inhibitors, can cause significant muscle toxicity and has been associated with elevations of liver transaminases.


METHODS
Muscle and liver adverse effects of simvastatin 40 mg daily were evaluated in a randomized placebo-controlled trial involving 20,536 UK patients with vascular disease or diabetes (in which a substantial reduction of cardiovascular mortality and morbidity has previously been demonstrated).


RESULTS
The excess incidence of myopathy in the simvastatin group was < 0.1% over the 5 years of the trial, and there were no significant differences between the treatment groups in the incidence of serious hepatobiliary disease.


CONCLUSIONS
Among the many different types of high-risk patient studied (including women, older individuals and those with low cholesterol levels), there was a very low incidence (< 0.1%) of myopathy during 5 years treatment with simvastatin 40 mg daily. The risk of hepatitis, if any, was undetectable even in this very large long-term trial. Routine monitoring of liver function tests during treatment with simvastatin 40 mg is not useful.
Armitage
Jane
J
Bowman
Louise
L
Collins
Rory
R
Parish
Sarah
S
Tobert
Jonathan
J
D000368:Aged; D000924:Anticholesteremic Agents / Q000633:toxicity*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000633:toxicity; D007004:Hypoglycemic Agents / Q000633:toxicity; D015994:Incidence; D008099:Liver / Q000187:drug effects* / Q000378:metabolism; D008875:Middle Aged; D009132:Muscles / Q000187:drug effects* / Q000378:metabolism; D009135:Muscular Diseases / Q000139:chemically induced; D010349:Patient Compliance; D010919:Placebos; D012307:Risk Factors; D019821:Simvastatin / Q000633:toxicity*; D016896:Treatment Outcome
D000924:Anticholesteremic Agents; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D007004:Hypoglycemic Agents; D010919:Placebos; D019821:Simvastatin