title: Low vitamin D does not predict statin associated muscle symptoms but is associated with transient increases in muscle damage and pain.
abstract: Low vitamin D (VITD) may contribute to statin-associated muscle symptoms (SAMS). We examined the influence of baseline and change in VITD in patients with verified SAMS.
  
  
  
  SAMS was verified in 120 patients with prior statin muscle complaints using 8-week randomized, double-blind crossover trials of simvastatin (SIMVA) 20 mg/d and placebo. 25 (OH)vitamin D was measured at each phase of the trial.
  
  
  
  Forty-three patients (35.8%) experienced muscle pain on SIMVA but not placebo, exhibiting confirmed SAMS. VITD (mean ± standard deviation) prior to SIMVA treatment was not different between patients who did (31.7 ± 12.1 ng/mL, n = 43) or did not (31.6 ± 10.3 ng/mL, n = 77) develop SAMS and did not predict SAMS (p = 0.96). The change in VITD with SIMVA treatment was not different between patients with and without SAMS (0.3 ± 5.9 vs. 0.2 ± 8.3 ng/mL, respectively) and did not predict SAMS (p = 0.96). The proportion of patients classified as VITD deficient (<20 ng/mL) did not differ between patients with (n = 16) and without (n = 10) SAMS (χ2= 1.45; p = 0.23), nor did the proportion of patients classified as VITD insufficient (<30 ng/mL) (n = 42 vs. 48; χ2< 0.01 and p = 0.94). Both baseline and on-statin VITD were inversely related to the change in creatine kinase (CK) with statin therapy (p = 0.01 and 0.02, respectively), independent of SAMS (p = 0.36 and 0.35).
  
  
  
  Baseline VITD, VITD deficiency/insufficiency and changes in VITD with statin therapy do not predict SAMS in patients with rigorously verified SAMS. However, low VITD may exacerbate statin-induced muscle injury and could contribute to SAMS development with a longer duration of statin treatment.
authors.affiliation: Department of Kinesiology, University of Connecticut, Storrs, CT, 06269, USA; Division of Cardiology, Henry Low Heart Center, Hartford Hospital, Hartford, CT, 06102, USA; University of Connecticut School of Medicine, Farmington, CT, 06032, USA. Electronic address: Beth.Taylor@uconn.edu.
authors.forename: Beth A
authors.initials: BA
authors.lastname: Taylor
authors.affiliation: Division of Cardiology, Henry Low Heart Center, Hartford Hospital, Hartford, CT, 06102, USA.
authors.forename: Lindsay
authors.initials: L
authors.lastname: Lorson
authors.affiliation: University of Connecticut School of Medicine, Farmington, CT, 06032, USA.
authors.forename: C Michael
authors.initials: CM
authors.lastname: White
authors.affiliation: Division of Cardiology, Henry Low Heart Center, Hartford Hospital, Hartford, CT, 06102, USA; University of Connecticut School of Medicine, Farmington, CT, 06032, USA.
authors.forename: Paul D
authors.initials: PD
authors.lastname: Thompson
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D003402:Creatine Kinase / Q000097:blood; D018592:Cross-Over Studies; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D063806:Myalgia / Q000097:blood / Q000139:chemically induced* / Q000175:diagnosis; D018570:Risk Assessment; D012307:Risk Factors; D019821:Simvastatin / Q000009:adverse effects*; D013997:Time Factors; D014807:Vitamin D / Q000031:analogs & derivatives / Q000097:blood; D014808:Vitamin D Deficiency / Q000097:blood / Q000150:complications* / Q000175:diagnosis
chemical_list: D015415:Biomarkers; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D014807:Vitamin D; C104450:25-hydroxyvitamin D; D019821:Simvastatin; D003402:Creatine Kinase
keywords: Muscle symptoms; Statin myalgia; Vitamin D deficiency