title: Statin-associated myopathy: from genetic predisposition to clinical management.
abstract: Statin-associated myopathy (SAM) represents a broad spectrum of disorders from insignificant myalgia to fatal rhabdomyolysis. Its frequency ranges from 1-5 % in clinical trials to 15-20 % in everyday clinical practice. To a large extent, these variations can be explained by the definition used. Thus, we propose a scoring system to classify statin-induced myopathy according to clinical and biochemical criteria as 1) possible, 2) probable or 3) definite. The etiology of this disorder remains poorly understood. Most probably, an underlying genetic cause is necessary for overt SAM to develop. Variants in a few gene groups that encode proteins involved in: i) statin metabolism and distribution (e.g. membrane transporters and enzymes; OATP1B1, ABCA1, MRP, CYP3A4), ii) coenzyme Q10 production (e.g. COQ10A and B), iii) energy metabolism of muscle tissue (e.g. PYGM, GAA, CPT2) and several others have been proposed as candidates which can predispose to SAM. Pharmacological properties of individual statin molecules (e.g. lipophilicity, excretion pathways) and patients´ characteristics influence the likelihood of SAM development. This review summarizes current data as well as our own results.
authors.affiliation: Third Department of Internal Medicine, First Faculty of Medicine, Charles University, Prague, Czech Republic. michal.vrablik@vfn.cz.
authors.forename: M
authors.initials: M
authors.lastname: Vrablik
authors.forename: L
authors.initials: L
authors.lastname: Zlatohlavek
authors.forename: T
authors.initials: T
authors.lastname: Stulc
authors.forename: V
authors.initials: V
authors.lastname: Adamkova
authors.forename: M
authors.initials: M
authors.lastname: Prusikova
authors.forename: L
authors.initials: L
authors.lastname: Schwarzova
authors.forename: J A
authors.initials: JA
authors.lastname: Hubacek
authors.forename: R
authors.initials: R
authors.lastname: Ceska
mesh_terms: D000818:Animals; D019468:Disease Management; D020022:Genetic Predisposition to Disease / Q000235:genetics*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000009:adverse effects*; D009135:Muscular Diseases / Q000139:chemically induced* / Q000235:genetics* / Q000628:therapy; D012307:Risk Factors
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors