Muscle pain and serum creatine kinase are not associated with low serum 25(OH) vitamin D levels in patients receiving statins.
OBJECTIVE
Vitamin D deficiency has been associated in some studies with nonspecific musculoskeletal pain and, more specifically, with statin-induced myalgia, which was ameliorated by high-dose vitamin D supplements. Our objective was to explore the association between vitamin D status and statin-induced myalgia and elevation of serum creatine kinase (CK).


METHODS
Retrospective cohort study, based on the electronic database of a health maintenance organization.


METHODS
Six thousand eight hundred and eight patients (71·5% women) to whom statins were dispensed during 2008 and who had ≥1 CK and 25-hydroxy vitamin D (25OHD) levels measured during statin exposure. Of these, 376 patients (5·5%) had switched from a first-line statin to atorvastatin because of muscle pain (n = 220) or other reasons (n = 156). Measurements; In the entire cohort, we compared serum CK levels among serum 25OHD quartiles. In addition, we compared CK and 25OHD levels among patients with myalgia, other switchers and nonswitchers.


RESULTS
The median 25OHD level in the entire cohort was 21·8 ng/ml [interquartile range (IQR), 16·3-27·4]. CK levels were marginally lower in patients in the lowest 25OHD quartile [median CK (IQR) in 25OHD quartiles 1-4, 87 (61-130), 90 (65-131), 91 (65-132) and 91 (67-131) IU/ml, respectively; P = 0·007]. 25OHD levels in statin switchers were similar to those in nonswitchers; moreover, there were no differences in 25OHD among switchers with muscle pain and other switchers.


CONCLUSIONS
Our findings do not support an association between low 25OHD levels and statin-induced myalgia or CK elevation.
Division of Health, Department of Pharmaceutics and Clinical Pharmacology, Maccabi Healthcare Services, Tel Aviv, Israel. kurnik_d@mac.org.il
Daniel
D
Kurnik
Israel
I
Hochman
Janet
J
Vesterman-Landes
Tali
T
Kenig
Itzhak
I
Katzir
Yosef
Y
Lomnicky
Hillel
H
Halkin
Ronen
R
Loebstein
D000328:Adult; D000368:Aged; D000924:Anticholesteremic Agents / Q000009:adverse effects / Q000627:therapeutic use; D015331:Cohort Studies; D003402:Creatine Kinase / Q000097:blood*; D003920:Diabetes Mellitus / Q000097:blood / Q000188:drug therapy; D005260:Female; D006331:Heart Diseases / Q000097:blood / Q000188:drug therapy; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009135:Muscular Diseases / Q000097:blood* / Q000139:chemically induced / Q000453:epidemiology; D059352:Musculoskeletal Pain / Q000097:blood* / Q000139:chemically induced / Q000453:epidemiology; D012189:Retrospective Studies; D014807:Vitamin D / Q000031:analogs & derivatives* / Q000097:blood; D014808:Vitamin D Deficiency / Q000097:blood / Q000139:chemically induced
D000924:Anticholesteremic Agents; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D014807:Vitamin D; C104450:25-hydroxyvitamin D; D003402:Creatine Kinase