title: Treatment Options for Statin-Associated Muscle Symptoms.
abstract: BACKGROUND
  About 4.6 million persons in Germany are now taking statins, i.e., drugs that inhibit the enzyme 3-hydroxy-3-methylglutaryl-coenzyme A (HMGCoA) reductase. Statins lower the concentration of low-density lipoproteins (LDL) and thereby lessen the rate of cardiovascular events; the size of this effect depends on the extent of lowering of the LDL cholesterol concentration. Muscle symptoms are a clinically relevant side effect of statin treatment.
  
  
  METHODS
  This review is based on pertinent publications retrieved by a selective literature search, and on the current recommendations of the European Atherosclerosis Society.
  
  
  RESULTS
  At least 5% of patients taking statins have statin-associated muscle symptoms (SAMS). The etiology of SAMS is heterogeneous. SAMS may seriously impair quality of life and cause complications of variable severity, up to and including rhabdomyolysis (in about 1 in 100,000 cases). SAMS often lead to a reduction in the prescribed dose of the statin, while also negatively affecting drug adherence. More than 90% of patients with SAMS can keep on taking statins over the long term and gain the full clinical benefit of statin treatment after a switch to another type of statin or a readjustment of the dose or frequency of administration. If the LDL cholesterol concentration is not adequately lowered while the patient is taking a statin in the highest tolerable dose, combination therapy is indicated.
  
  
  CONCLUSIONS
  SAMS are important adverse effects of statin treatment because they lessen drug adherence. Patients with SAMS should undergo a thorough diagnostic evaluation followed by appropriate counseling. In most cases, statins can be continued, with appropriate adjustments, even in the aftermath of SAMS.
authors.affiliation: Department of Internal Medicine III-Cardiology, Angiology and Intensive Care Medicine, Saarland University Medical Center, Homburg/Saar, Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University Graz, Department of Prevention, Rehabilitation and Sports Medicine and Else Kroener-Fresenius-Center for Nutritional Medicine, Klinikum rechts der Isar, Technische Universität München, Preventive Medicine, Department of General and Interventional Cardiology, University Medical Center Hamburg-Eppendorf, Hamburg, Department and Out-Patient Care of Neurology, Charité-Universitätsmedizin Berlin, Synlab Akademie, Synlab Services GmbH, Mannheim and Augsburg.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Laufs
authors.forename: Hubert
authors.initials: H
authors.lastname: Scharnagl
authors.forename: Martin
authors.initials: M
authors.lastname: Halle
authors.forename: Eberhard
authors.initials: E
authors.lastname: Windler
authors.forename: Matthias
authors.initials: M
authors.lastname: Endres
authors.forename: Winfried
authors.initials: W
authors.lastname: März
mesh_terms: D000924:Anticholesteremic Agents / Q000008:administration & dosage / Q000009:adverse effects; D004305:Dose-Response Relationship, Drug; D016903:Drug Monitoring / Q000379:methods*; D019317:Evidence-Based Medicine; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage / Q000009:adverse effects*; D000960:Hypolipidemic Agents / Q000008:administration & dosage / Q000009:adverse effects; D008487:Medical History Taking; D009135:Muscular Diseases / Q000139:chemically induced* / Q000517:prevention & control*; D016896:Treatment Outcome
chemical_list: D000924:Anticholesteremic Agents; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D000960:Hypolipidemic Agents