title: Managing statin-induced muscle toxicity in a lipid clinic.
abstract: OBJECTIVE
  Muscle toxicity is the most significant adverse effect related to statins. The aim of the study was to analyse the clinical course and achievement of LDL-C target levels in patients with statin-induced muscle toxicity.
  
  
  METHODS
  All patients who were referred to the lipid clinic because of statin-induced muscle toxicity, or developed it during follow-up, or did not reach LDL-C target levels because of its previous occurrence, and attended the clinic for at least three follow-up visits, were eligible. Files were reviewed for demographic and clinical parameters, coronary heart disease risk level, the severity of muscle injury, the type of statin and dose that caused the adverse effects, the clinical approach and outcome, and whether the LDL-C target level was achieved.
  
  
  RESULTS
  The study group consisted of 54 patients. Twenty-three (43%) patients complained of myalgia, 23 (43%) had asymptomatic serum creatine kinase (CK) level elevation, five (9%) had myopathy and three (5%) had rhabdomyolysis. Fifty of the patients (93%) continued statin therapy and 43 (80%) achieved the LDL-C target level.
  
  
  CONCLUSIONS
  We show that for the majority of patients with statin-induced muscle toxicity, statin therapy can be safely and effectively continued. In cases of asymptomatic CK levels <3-5 upper limit of normal (ULN), statin treatment should not be interrupted. When CK levels >3-5 ULN or when various symptomatic muscle adverse reactions are present, statins rechallenge, after a recovery period, should be individualized either by a low dose of a potent statin or by a less potent statin. An additional lipid medication is advised if the target levels are not achieved.
authors.affiliation: Department of Medicine, Meir Medical Center, Kfar Saba, Israel.
authors.forename: O
authors.initials: O
authors.lastname: Blaier
authors.forename: M
authors.initials: M
authors.lastname: Lishner
authors.forename: A
authors.initials: A
authors.lastname: Elis
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D008078:Cholesterol, LDL / Q000097:blood; D003327:Coronary Disease / Q000453:epidemiology; D003402:Creatine Kinase / Q000097:blood; D016903:Drug Monitoring; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D006937:Hypercholesterolemia / Q000188:drug therapy*; D007557:Israel / Q000453:epidemiology; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D009132:Muscles / Q000187:drug effects; D009135:Muscular Diseases / Q000097:blood / Q000139:chemically induced* / Q000175:diagnosis / Q000503:physiopathology; D009220:Myositis / Q000453:epidemiology; D010044:Outpatient Clinics, Hospital; D010147:Pain Measurement; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D012206:Rhabdomyolysis / Q000453:epidemiology; D012307:Risk Factors; D012720:Severity of Illness Index
chemical_list: D008078:Cholesterol, LDL; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D003402:Creatine Kinase