title: Low vitamin D as a risk factor for the development of myalgia in patients taking high-dose simvastatin: a retrospective review.
abstract: BACKGROUND
  Statins are the treatment of choice for dyslipidemia, primarily lowering elevated LDL-C levels and reducing the occurrence of major cardiovascular events. In June 2011, the Food and Drug Administration issued a warning regarding the use of high-dose simvastatin 80 mg and its risk of myopathy.
  
  
  OBJECTIVE
  The incidence of myalgia, myopathy, and rhabdomyolysis was analyzed in a veteran population prescribed simvastatin 80 mg. Risk factors for myalgia were examined and compared with the results of recently published studies.
  
  
  METHODS
  This was a retrospective medical record review of 450 patients who were prescribed simvastatin 80 mg at the Veterans Affairs Western New York Healthcare System between August 1, 2006, and July 31, 2011. Records were examined for evidence of myalgia, myopathy (incipient or definite), and rhabdomyolysis. Variables that may have contributed to the development of myalgia were also collected and analyzed.
  
  
  RESULTS
  Myalgia was reported by 50 patients (11.1%), whereas rhabdomyolysis developed in 1 patient (0.22%). No patient fit the criteria for myopathy (incipient or definite). Myalgia was statistically more likely to occur in younger patients, patients with a history of myalgia, and patients with low vitamin D levels. The mean (SD) vitamin D level in patients experiencing myalgia was 26.2 (12.9) versus 36.3 (11.8) ng/mL. The 25-hydroxyvitamin D level in those who reported myalgia was approximately 10 ng/mL lower compared with those who tolerated simvastatin 80 mg (P = 0.0003). There was no statistically significant association between length of therapy and development of myalgia.
  
  
  CONCLUSIONS
  A lower incidence of adverse muscle events with high-dose simvastatin 80 mg was found in patients with higher vitamin D levels, suggesting that correction of 25-hydroxyvitamin D levels before statin therapy initiation may mitigate one risk factor in the development of statin-related myalgia. Vitamin D insufficiency appears to be a risk factor for the development of myalgia.
authors.affiliation: Department of Pharmacy, Veterans Affairs Western New York Healthcare System, Buffalo, New York. Electronic address: kari.mergenhagen@va.gov.
authors.forename: Kari
authors.initials: K
authors.lastname: Mergenhagen
authors.affiliation: Department of Pharmacy, Erie County Medical Center Corporation, Buffalo, New York.
authors.forename: Michael
authors.initials: M
authors.lastname: Ott
authors.affiliation: Department of Pharmacy, Veterans Affairs Western New York Healthcare System, Buffalo, New York.
authors.forename: Kerry
authors.initials: K
authors.lastname: Heckman
authors.affiliation: Department of Pharmacy, Veterans Affairs Western New York Healthcare System, Buffalo, New York.
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Rubin
authors.affiliation: Department of Pharmacy, Veterans Affairs Western New York Healthcare System, Buffalo, New York.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Kellick
mesh_terms: D000328:Adult; D000368:Aged; D004305:Dose-Response Relationship, Drug; D006801:Humans; D016015:Logistic Models; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D009135:Muscular Diseases / Q000139:chemically induced; D063806:Myalgia / Q000097:blood / Q000139:chemically induced*; D012189:Retrospective Studies; D012206:Rhabdomyolysis / Q000139:chemically induced; D012307:Risk Factors; D019821:Simvastatin / Q000008:administration & dosage* / Q000009:adverse effects*; D014807:Vitamin D / Q000097:blood; D014808:Vitamin D Deficiency / Q000150:complications*; D055815:Young Adult
chemical_list: D014807:Vitamin D; D019821:Simvastatin
keywords: muscle pain; myalgia; myopathy; rhabdomyolysis; simvastatin; statins; vitamin D