Statin associated muscle symptoms: An update and review
Introduction
Statin therapy is one of the primary modalities for addressing dyslipidemia and reducing the risk of atherosclerotic cardiovascular (CV) disease (CVD;ASCVD). This results from evidence that statins have strong efficacy in not only improving the cholesterol profile, but also in reducing negative CVD outcomes. Studies have shown that each 1 mmol/L (approximately 39 mg/dL) reduction in low-density lipoprotein cholesterol(LDL-C) is associated with a 25% reduction in major adverse CVD events during each year (after the first) that it continues to be taken.1 There is a similar correlation with mortality, specifically with a 20% reduction in coronary artery disease-related deaths and a 10% reduction in all-cause mortality over a 5-year period.1 When looking more specifically at intensifying statin therapy, a further reduction in LDL-C by 0.5 mmol/L is correlated with an additional 15% reduction in the rate of deaths. Overall, this relates to a 28% risk reduction for every 1 mmol/L decrease in LDL-C.1 Much of this data was obtained from studies done in large cohorts with variable underlying risk levels for ASCVD, but pooled cohorts of patients with higher risk have shown similar, if not stronger results for the benefit of statin therapy.1 These data emphasize the importance of initiating and appropriately titrating the dose of statin therapy when indicated.
Despite the aforementioned data, a significant amount of the population who would benefit from statin therapy is either not on an appropriate dose, or not taking the medication at all. Specifically, discontinuation rates of statins within the first two years of therapy have been shown to approach 75%.2 The primary reason for patients not being on appropriate statin therapy is due to statin associated muscle symptoms (SAMS).2 SAMS are broadly defined as symptoms of muscle discomfort or pain associated with statin therapy. While some patients may not be able to tolerate appropriate statin therapy due to these muscle symptoms, many of these symptoms are either unrelated to statin therapy or can be addressed and managed through multiple means without having to discontinue statin therapy. This manuscript aims to provide an overview of the information that is currently known about statin therapy and SAMS. Through this information, physicians will be better able to evaluate and manage SAMS so that a greater number of patients may receive the CV benefits that statin therapy can provide.
Section snippets
Prevalence of SAMS
A major question surrounding SAMS is the true prevalence within society. This has been difficult to determine, as there are significant discrepancies between data from observational studies and registry reviews when compared to that of randomized controlled trials.3 While large scale observational studies and registry reviews have shown an incidence of SAMS ranging from 10 to 29%, lack of placebo comparisons prevents the ability to establish a causal relationship with statin therapy.2
Conclusion
Statins are the mainstay of therapy for primary and secondary prevention of cardiovascular disease due to their proven ability to reduce low-density lipoprotein cholesterol (LDL-C) and reduce cardiovascular morbidity and mortality. However, despite their proven benefits they are underutilized due to the perceived prevalence of statin associated muscle symptoms (SAMS), the primary reason that most patients discontinue statin therapy or choose not to start the medication. This perception has
Declaration of Competing Interest
None.
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