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 2024/10/07 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.