title: Rechallenging Statin Therapy in Veterans With Statin-Induced Myopathy Post Vitamin D Replenishment.
abstract: BACKGROUND
  Statins are the primary class of medications used to lower cholesterol and reduce risks for coronary heart disease. However, statin muscular adverse effects are one of the main reasons for statin nonadherence and a barrier to cardiovascular risk reduction.
  
  
  OBJECTIVE
  The primary objective of our study was to examine the effect of replenishing vitamin D on statin-induced myopathy in veteran patients who failed to maintain statin therapy in a pharmacist-run ambulatory care setting. Secondary objectives were to examine changes in patients' vitamin D levels, fasting lipid profiles, and achievement of lipid goals after reinitiation of statin therapy.
  
  
  METHODS
  This was a retrospective cohort study of veteran patients conducted at a pharmacist-managed cholesterol-optimization clinic. Patients with low-serum vitamin D, history of statin-induced myopathy, and who received vitamin D replenishment prior to rechallenging statin therapy between December 1, 2008, and April 1, 2015, were identified. The primary outcome was the percentage of patients who maintained their statin therapy at 12 months after statin reinitiation.
  
  
  RESULTS
  Twenty-seven patients met the study criteria. All patients were able to maintain their statin therapy without myalgia after vitamin D supplementation. Eleven patients (40.7%) tolerated their previously failed statins. The most frequently restarted statins were atorvastatin, pravastatin, and rosuvastatin. A 22% to 30% increase in the number of patients who achieved cholesterol goals based on the national lipid guidelines was observed at 12-month follow-up.
  
  
  CONCLUSIONS
  Replenishing low vitamin D in patients with statin-induced myopathy appears to be an effective strategy in improving medication adherence and subsequently preventing cardiovascular and mortality events.
authors: 1 Department of Pharmacy Practice and Administration, College of Pharmacy, Western University of Health Sciences, Pomona, CA, USA.|2 Department of Pharmacy, Veterans Affairs Loma Linda Healthcare System, Loma Linda, CA, USA.
authors: Jenny H
authors: JH
authors: Kang
authors: 2 Department of Pharmacy, Veterans Affairs Loma Linda Healthcare System, Loma Linda, CA, USA.
authors: Quynh-Nhu
authors: QN
authors: Nguyen
authors: 2 Department of Pharmacy, Veterans Affairs Loma Linda Healthcare System, Loma Linda, CA, USA.
authors: Juleann
authors: J
authors: Mutka
authors: 1 Department of Pharmacy Practice and Administration, College of Pharmacy, Western University of Health Sciences, Pomona, CA, USA.|2 Department of Pharmacy, Veterans Affairs Loma Linda Healthcare System, Loma Linda, CA, USA.
authors: Quang A
authors: QA
authors: Le
mesh_terms: D000368:Aged; D002784:Cholesterol / Q000097:blood; D015331:Cohort Studies; D005260:Female; D006787:Hospitals, Veterans / Q000639:trends; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009135:Muscular Diseases / Q000097:blood / Q000139:chemically induced* / Q000188:drug therapy*; D010044:Outpatient Clinics, Hospital / Q000639:trends; D012189:Retrospective Studies; D014728:Veterans; D014807:Vitamin D / Q000008:administration & dosage* / Q000097:blood; D014808:Vitamin D Deficiency / Q000097:blood / Q000188:drug therapy*
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D014807:Vitamin D; D002784:Cholesterol
keywords: HMG-CoA reductase inhibitors; pharmacist-managed clinic; statin; statin-induced myopathy; vitamin D deficiency