title: Statin-Associated Myopathy in a Pediatric Preventive Cardiology Practice.
abstract: To describe muscle-related statin adverse effects in real-world pediatric practice.
  
  
  
  Using prospectively collected quality improvement data from a pediatric preventive cardiology practice, we compared serum creatine kinase (CK) levels among patients prescribed and not prescribed statins, and pre-/poststatin initiation. Multivariable mixed-effect models were constructed accounting for repeated measures, examining the effect of statins on log-transformed CK (lnCK) levels adjusted for age, sex, weight, season, insurance type, and race/ethnicity.
  
  
  
  Among 1501 patients seen over 3.5 years, 474 patients (14?±?4 years, 47% female) had at least 1 serum CK measured. Median (IQR) CK levels of patients prescribed (n?=?188 patients, 768 CK measurements) and not prescribed statins (n?=?351 patients, 682 CK measurements) were 107 (83) IU/L and 113 (81) IU/L, respectively. In multivariable-adjusted models, lnCK levels did not differ based on statin use (??=?0.02 [SE 0.05], P?=?.7). Among patients started on statins (n?=?86, 130 prestatin and 292 poststatin CK measurements), median CK levels did not differ in adjusted models (? for statin use on lnCK?=?.08 [SE .07], P?=?.2). There was a clinically insignificant increase in CK over time (??=?.08 [SE .04], P?=?.04 per year). No muscle symptoms or rhabdomyolysis were reported among patients with high CK levels.
  
  
  
  In a real-world practice, pediatric patients using statins did not experience higher CK levels, nor was there a meaningful CK increase with statin initiation. These data suggest the limited utility to checking CK in the absence of symptoms, supporting current guidelines.
authors.affiliation: Department of Cardiology, Boston Children's Hospital.
authors.forename: Philip K
authors.initials: PK
authors.lastname: Johnson
authors.affiliation: Department of Cardiology, Boston Children's Hospital.
authors.forename: Michael M
authors.initials: MM
authors.lastname: Mendelson
authors.affiliation: Department of Cardiology, Boston Children's Hospital.
authors.forename: Annette
authors.initials: A
authors.lastname: Baker
authors.affiliation: Department of Cardiology, Boston Children's Hospital.
authors.forename: Heather H
authors.initials: HH
authors.lastname: Ryan
authors.affiliation: Department of Cardiology, Boston Children's Hospital.
authors.forename: Shira
authors.initials: S
authors.lastname: Warren
authors.affiliation: Institute for Relevant Clinical Data Analytics.
authors.forename: Dionne
authors.initials: D
authors.lastname: Graham
authors.affiliation: Department of Cardiology, Boston Children's Hospital.
authors.forename: Suzanne S
authors.initials: SS
authors.lastname: Griggs
authors.affiliation: Department of Medicine, Gastroenterology Division, Boston Children's Hospital, Boston, MA.
authors.forename: Nirav K
authors.initials: NK
authors.lastname: Desai
authors.affiliation: Department of Cardiology, Boston Children's Hospital.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Yellen
authors.affiliation: Department of Cardiology, Boston Children's Hospital.
authors.forename: Lucy
authors.initials: L
authors.lastname: Buckley
authors.affiliation: Department of Cardiology, Boston Children's Hospital.
authors.forename: Justin P
authors.initials: JP
authors.lastname: Zachariah
authors.affiliation: Department of Cardiology, Boston Children's Hospital. Electronic address: sarah.deferranti@cardio.chboston.org.
authors.forename: Sarah D
authors.initials: SD
authors.lastname: de Ferranti
mesh_terms: D000293:Adolescent; D001900:Boston; D003402:Creatine Kinase / Q000097:blood*; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D008297:Male; D015999:Multivariate Analysis; D009135:Muscular Diseases / Q000097:blood / Q000139:chemically induced*; D010372:Pediatrics
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D003402:Creatine Kinase
keywords: adolescent; child; cholesterol; creatine kinase; lipid; myopathy; statins