title: Risk identification and possible countermeasures for muscle adverse effects during statin therapy.
abstract: The use of statins for cardiovascular disease prevention is clearly supported by clinical evidence. However, in January 2014 the U.S. Food and Drug Administration released an advice on statin risk reporting that "statin benefit is indisputable, but they need to be taken with care and knowledge of their side effects". Among them the by far most common complication is myopathy, ranging from common but clinically benign myalgia to rare but life-threatening rhabdomyolysis. This class side effect appears to be dose dependent, with more lipophilic statin (i.e., simvastatin) carrying a higher overall risk. Hence, to minimize statin-associated myopathy, clinicians should take into consideration a series of factors that potentially increase this risk (i.e., drug-drug interactions, female gender, advanced age, diabetes mellitus, hypothyroidism and vitamin D deficiency). Whenever it is appropriate to stop statin treatment, the recommendations are to stay off statin until resolution of symptoms or normalization of creatine kinase values. Afterwards, clinicians have several options to treat dyslipidemia, including the use of a lower dose of the same statin, intermittent non-daily dosing of statin, initiation of a different statin, alone or in combination with nonstatin lipid-lowering agents, and substitution with red yeast rice.
authors: Dipartimento di Scienze Farmacologiche e Biomolecolari, Università degli Studi di Milano, Italy; Centro Dislipidemie, Ospedale Niguarda Cà Granda, Milan, Italy. Electronic address: paolo.magni@unimi.it.
authors: Paolo
authors: P
authors: Magni
authors: Dipartimento di Scienze Farmacologiche e Biomolecolari, Università degli Studi di Milano, Italy.
authors: Chiara
authors: C
authors: Macchi
authors: Centro Dislipidemie, Ospedale Niguarda Cà Granda, Milan, Italy.
authors: Beatrice
authors: B
authors: Morlotti
authors: Dipartimento di Scienze Farmacologiche e Biomolecolari, Università degli Studi di Milano, Italy; Centro Dislipidemie, Ospedale Niguarda Cà Granda, Milan, Italy.
authors: Cesare R
authors: CR
authors: Sirtori
authors: Dipartimento di Scienze Farmacologiche e Biomolecolari, Università degli Studi di Milano, Italy; Centro Dislipidemie, Ospedale Niguarda Cà Granda, Milan, Italy.
authors: Massimiliano
authors: M
authors: Ruscica
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000924:Anticholesteremic Agents / Q000627:therapeutic use*; D000069472:Colesevelam Hydrochloride / Q000627:therapeutic use; D003402:Creatine Kinase / Q000097:blood; D004347:Drug Interactions; D004359:Drug Therapy, Combination; D050171:Dyslipidemias / Q000188:drug therapy* / Q000453:epidemiology; D000069438:Ezetimibe / Q000627:therapeutic use; D005229:Fatty Acids, Monounsaturated / Q000009:adverse effects; D005260:Female; D000077340:Fluvastatin; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000009:adverse effects*; D007211:Indoles / Q000009:adverse effects; D008297:Male; D009135:Muscular Diseases / Q000139:chemically induced / Q000378:metabolism; D063806:Myalgia / Q000097:blood / Q000139:chemically induced*; D012206:Rhabdomyolysis / Q000097:blood / Q000139:chemically induced*; D018570:Risk Assessment; D012307:Risk Factors; D000068718:Rosuvastatin Calcium / Q000009:adverse effects; D012737:Sex Factors; D014808:Vitamin D Deficiency / Q000453:epidemiology
chemical_list: D000924:Anticholesteremic Agents; D005229:Fatty Acids, Monounsaturated; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D007211:Indoles; D000077340:Fluvastatin; D000068718:Rosuvastatin Calcium; D003402:Creatine Kinase; D000069438:Ezetimibe; D000069472:Colesevelam Hydrochloride
keywords: Cardiovascular risk; Creatine kinase; Skeletal muscle toxicity; Statin-related myopathy