Harper CR, Jacobson TA.
Emory University, Atlanta, GA, USA.
Curr Atheroscler Rep 2010;12:322–30.
Editor’s note: This article summarizes the current thinking on statin myopathy and provides some useful clinical pointers for the management of these challenging patients. The 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins) are the most widely used treatments for the reduction of low-density lipoprotein cholesterol levels and cardiovascular events. In a systematic review of 20 clinical trials, the incidence of myopathy and minor muscle pain was found to be 195 cases per 100 000 patient-years, and the incidence of rhabdomyolysis was 1.6 cases per 100 000 patient-years (Am J Cardiol 2006;97:52–60C). However, the frequency with which the physician encounters statin-induced myopathy may be higher than that reported in clinical trials, as trials exclude high-risk patients and those with laboratory abnormalities. The US Food and Drug Administration adverse events reporting system shows an incidence of rhabdomyolysis of 0.7 cases per 100 000 patient-years, although such a voluntary reporting system will again result in under-reporting of adverse events. Perhaps the most accurate information available is that from the PRIMO (Prediction of Muscular Risk in Observational Conditions) trial, a 12-month, prospective, community-based, observational study, in which >7900 hyperlipidemic patients with high-dose statin treatment were enrolled (Cardiovasc Drugs Ther 2005;19:403–14). Muscle symptoms were reported in 11% of patients. The frequency of statin myopathy with various agents was as follows: simvastatin (18.2%), atorvastatin (14.9%), pravastatin (10.9%), and fluvastatin (5.1%).