title: Vitamin D deficiency, myositis-myalgia, and reversible statin intolerance.
abstract: OBJECTIVE
  In 150 hypercholesterolemic patients, unable to tolerate ≥1 statin because of myositis-myalgia, selected by low (<32 ng/ml) serum 25 (OH) vitamin D, we prospectively assessed whether vitamin D supplementation with resolution of vitamin D deficiency would result in statin tolerance, free of myositis-myalgia.
  
  
  METHODS
  We studied 74 men, 76 women, median age 60, 131 white, 17 black and 2 other. On no statins, 50,000 units of vitamin D was given twice a week for 3 weeks, and then continued once a week. After 3 weeks on vitamin D, statins were restarted. Patients were re-assessed on statins and vitamin D every 3 to 4 months, with serial measures of serum 25 (OH) vitamin D, creatine phosphokinase (CPK), LDL cholesterol (LDLC) and assessment of myositis-myalgia.
  
  
  METHODS
  Percentage of patients myalgia-free on vitamin D plus reinstituted statins, serum 25 (OH) vitamin D, CPK, and LDLC on reinstituted statins and concurrent vitamin D supplementation.
  
  
  RESULTS
  On vitamin D supplementation plus re-instituted statins for a median of 8.1 months, 131 of the 150 patients (87%) were free of myositis-myalgia and tolerated the statins well. Serum 25 (OH) vitamin D increased from median 21 to 40 ng/ml (p < 0.001), and normalized (≥32 ng/ml) in 117 (78%) of 150 previously vitamin D deficient, statin-intolerant patients. Median LDLC decreased from 146 mg/dl to 95 mg/dl, p < 0.001.
  
  
  CONCLUSIONS
  Symptomatic myositis-myalgia in hypercholesterolemic statin-treated patients with concurrent serum 25 (OH) vitamin D deficiency may reflect a reversible interaction between vitamin D deficiency and statins on skeletal muscle causing myalgia.
authors: Cholesterol Center, Jewish Hospital of Cincinnati, Cincinnati, OH, USA. cjglueck@health-partners.org
authors: Charles J
authors: CJ
authors: Glueck
authors: Shaaista B
authors: SB
authors: Budhani
authors: Silpa S
authors: SS
authors: Masineni
authors: Cesar
authors: C
authors: Abuchaibe
authors: Naseer
authors: N
authors: Khan
authors: Ping
authors: P
authors: Wang
authors: Naila
authors: N
authors: Goldenberg
mesh_terms: D008078:Cholesterol, LDL / Q000097:blood; D019587:Dietary Supplements; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects*; D006937:Hypercholesterolemia / Q000097:blood / Q000150:complications / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D009135:Muscular Diseases / Q000097:blood / Q000139:chemically induced / Q000150:complications / Q000517:prevention & control*; D009220:Myositis / Q000097:blood / Q000139:chemically induced / Q000150:complications / Q000517:prevention & control*; D013997:Time Factors; D014807:Vitamin D / Q000008:administration & dosage / Q000097:blood / Q000627:therapeutic use*; D014808:Vitamin D Deficiency / Q000097:blood / Q000150:complications / Q000188:drug therapy*; D028761:Withholding Treatment
chemical_list: D008078:Cholesterol, LDL; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D014807:Vitamin D