title: Statin Intolerance Because of Myalgia, Myositis, Myopathy, or Myonecrosis Can in Most Cases be Safely Resolved by Vitamin D Supplementation.
abstract: BACKGROUND
  Low serum vitamin D can cause myalgia, myositis, myopathy, and myonecrosis. Statin-induced myalgia is a major and common cause of statin intolerance. Low serum vitamin D and statins, additively or synergistically, cause myalgia, myositis, myopathy, and/or myonecrosis. Statin-induced myalgia in vitamin D deficient patients can often be resolved by vitamin D supplementation, normalizing serum vitamin D levels.
  
  
  OBJECTIVE
  In 74 men and 72 women (age 59 ± 14 years) intolerant to ≥2 statins because of myalgia, myositis, myopathy, or myonecrosis and found to have low (<32 ng/mL) serum vitamin D, we prospectively assessed whether vitamin D supplementation (vitamin D2: 50,000-100,000 units/week) to normalize serum vitamin D would allow successful rechallenge therapy with statins.
  
  
  METHODS
  Follow-up evaluation on vitamin D supplementation was done on 134 patients at 6 months (median 5.3), 103 patients at 12 months (median 12.2), and 82 patients at 24 months (median 24).
  
  
  RESULTS
  Median entry serum vitamin D (22 ng/mL, 23 ng/mL, and 23 ng/mL) rose at 6 months, 12 months, and 24 months follow-up to 53 ng/mL, 53 ng/mL, and 55 ng/mL, respectively, (P < .0001 for all) on vitamin D therapy (50,000-100,000 units/week). On vitamin D supplementation, serum vitamin D normalized at 6 months, 12 months, and 24 months follow-up in 90%, 86%, and 91% of the patients, respectively. On rechallenge with statins while on vitamin D supplementation, median low-density lipoprotein cholesterol (LDLC) fell from the study entry (167 mg/dL, 164 mg/dL, and 158 mg/dL) to 90 mg/dL, 91 mg/dL, and 84 mg/dL, respectively, (P < .0001 for all). On follow-up at median 6 months, 12 months, and 24 months on statins and vitamin D, 88%, 91%, and 95% of the previously statin-intolerant patients, respectively, were free of myalgia, myositis, myopathy, and/or myonecrosis.
  
  
  CONCLUSIONS
  Statin intolerance because of myalgia, myositis, myopathy, or myonecrosis associated with low serum vitamin D can be safely resolved by vitamin D supplementation (50,000-100,000 units /week) in most cases (88-95%).
authors.affiliation: Department of Internal Medicine, The Cholesterol, Metabolism and Thrombosis Center, Jewish Hospital of Cincinnati, Cincinnati, Ohio, USA.
authors.forename: Maksim
authors.initials: M
authors.lastname: Khayznikov
authors.affiliation: Department of Internal Medicine, The Cholesterol, Metabolism and Thrombosis Center, Jewish Hospital of Cincinnati, Cincinnati, Ohio, USA.
authors.forename: Kallish
authors.initials: K
authors.lastname: Hemachrandra
authors.affiliation: Department of Internal Medicine, The Cholesterol, Metabolism and Thrombosis Center, Jewish Hospital of Cincinnati, Cincinnati, Ohio, USA.
authors.forename: Ramesh
authors.initials: R
authors.lastname: Pandit
authors.affiliation: Department of Internal Medicine, The Cholesterol, Metabolism and Thrombosis Center, Jewish Hospital of Cincinnati, Cincinnati, Ohio, USA.
authors.forename: Ashwin
authors.initials: A
authors.lastname: Kumar
authors.affiliation: Department of Internal Medicine, The Cholesterol, Metabolism and Thrombosis Center, Jewish Hospital of Cincinnati, Cincinnati, Ohio, USA.
authors.forename: Ping
authors.initials: P
authors.lastname: Wang
authors.affiliation: Department of Internal Medicine, The Cholesterol, Metabolism and Thrombosis Center, Jewish Hospital of Cincinnati, Cincinnati, Ohio, USA.
authors.forename: Charles J
authors.initials: CJ
authors.lastname: Glueck
keywords: Myalgia; myonecrosis; myopathy; myositis; rhabdomyolysis; statin intolerance; statin rechallenge; vitamin D deficiency; vitamin D supplementation
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