RT Book, Section
A1 Seip, Richard L.
A1 Rivera, Nahir
A1 Ruano, Gualberto
A1 Thompson, Paul D.
A2 Murray, Michael F.
A2 Babyatsky, Mark W.
A2 Giovanni, Monica A.
A2 Alkuraya, Fowzan S.
A2 Stewart, Douglas R.
SR Print(0)
ID 1102698660
T1 Statin-Induced Neuromyopathy
T2 Clinical Genomics: Practical Applications in Adult Patient Care
YR 2014
FD 2014
PB McGraw-Hill Education
PP New York, NY
SN 9780071622448
LK accessmedicine.mhmedical.com/content.aspx?aid=1102698660
RD 2024/04/19
AB Disease  summary:Statins  may  cause  a  series  of  musculoskeletal  and  neuromuscular  disturbances  and  diseases,  including  rhabdomyolysis  and  mild  serum  creatine  kinase  (CK)  elevations.  Genetic  factors  have  been  associated  with  an  increased  risk  of  statin-induced  myopathy.Statins  or  3-hydroxy-3-methylglutaryl  coenzyme  A  reductase  inhibitors  are  widely  prescribed  because  of  their  cardiovascular  benefits.  Statins  are  well  tolerated  by  most  patients  at  low  starting  dosages  but  can  produce  statin-induced  neuromyopathy  and  their  usage  is  ultimately  limited  by  toxicity.The  American  College  of  Cardiology  (ACC)/American  Heart  Association  (AHA)/National  Heart,  Lung,  and  Blood  Institute  (NHLBI)  definitions  and  terminology  are  widely  used  in  the  literature  and  therefore  used  here.  They  have  defined  four  syndromes:  Statin  myopathy  (any  muscle  complaints  related  to  statins)Myalgia  (muscle  complaints  without  serum  CK  elevation)Myositis  (muscle  complaints  with  CK  elevation  >10  ULN  [upper  limit  of  normal])Rhabdomyolysis  (CK  activity  >10-fold  ULN  with  an  elevated  creatinine  level  consistent  with  brown  urine  and  urinary  myoglobin)Muscle  complaints  encompass  aches,  cramps,  pain,  tenderness,  weakness,  fatigue,  and  heaviness  and  are  broadly  categorized  as  neuromuscular  side  effects  (NMSEs).NMSE  occur  in  approximately  10%  of  patients  during  high-dose  therapy,  affecting  compliance  to  therapy.  NMSEs  vary  in  extent  among  drugs  and  from  patient  to  patient.Increased  serum  CK  activity  provides  the  predominant  means  for  assessing  the  degree  of  muscle  injury,  with  elevation  of  CK  activity  to  greater  than  10-fold  ULN  suggested  as  indicating  severe  statin-induced  neuromyopathy.  Elevation  of  CK  to  greater  than  fourfold  ULN  with  statin  therapy  may  warrant  testing  for  underlying  metabolic  muscle  disease.  However,  serum  CK  activity  correlates  poorly  with  the  more  common  and  less  severe  NMSE,  can  be  normal  in  patients  with  NMSE,  and  is  not  an  effective  clinical  marker  for  common  NMSE.