title: Rarity of anti-3-hydroxy-3-methylglutaryl-coenzyme A reductase antibodies in statin users, including those with self-limited musculoskeletal side effects.
abstract: OBJECTIVE
  Statins, among the most commonly prescribed medications, are associated with a wide range of musculoskeletal side effects. These include a progressive autoimmune myopathy with anti-3-hydroxy-3-methylglutaryl-coenzyme A reductase (anti-HMGCR) antibodies that requires immunosuppression. However, it remains unknown whether these antibodies are found in statin users with and without self-limited musculoskeletal side effects; this limits their diagnostic utility. The current work assessed the prevalence of anti-HMGCR antibodies in these groups of statin users.
  
  
  METHODS
  We determined the prevalence of anti-HMGCR antibodies in 1,966 participants (including 763 current statin users) in a substudy of the community-based Atherosclerosis Risk in Communities (ARIC) Study and 98 French Canadian subjects with familial hypercholesterolemia, including 51 with documented statin intolerance.
  
  
  RESULTS
  No participant in the ARIC substudy, including those with past or current statin exposure at the time of sample collection, had anti-HMGCR antibodies. Similarly, none of 51 patients with self-limited statin intolerance or 47 statin-tolerant patients receiving maximal statin therapy were anti-HMGCR positive.
  
  
  CONCLUSIONS
  The majority of patients with and without statin exposure, including those with self-limited statin intolerance, do not develop anti-HMGCR antibodies. Therefore, anti-HMGCR antibodies are highly specific for those with an autoimmune myopathy.
authors.affiliation: Johns Hopkins University, Baltimore, Maryland, USA. amammen@jhmi.edu
authors.forename: Andrew L
authors.initials: AL
authors.lastname: Mammen
authors.forename: Katherine
authors.initials: K
authors.lastname: Pak
authors.forename: Emma K
authors.initials: EK
authors.lastname: Williams
authors.forename: Diane
authors.initials: D
authors.lastname: Brisson
authors.forename: Joe
authors.initials: J
authors.lastname: Coresh
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Selvin
authors.forename: Daniel
authors.initials: D
authors.lastname: Gaudet
mesh_terms: D000924:Anticholesteremic Agents / Q000009:adverse effects*; D001323:Autoantibodies / Q000097:blood*; D001327:Autoimmune Diseases / Q000097:blood / Q000139:chemically induced* / Q000276:immunology; D005260:Female; D006801:Humans; D006903:Hydroxymethylglutaryl CoA Reductases / Q000276:immunology*; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009135:Muscular Diseases / Q000097:blood / Q000139:chemically induced* / Q000276:immunology; D059352:Musculoskeletal Pain / Q000097:blood / Q000139:chemically induced* / Q000276:immunology; D011446:Prospective Studies
chemical_list: D000924:Anticholesteremic Agents; D001323:Autoantibodies; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D006903:Hydroxymethylglutaryl CoA Reductases