 |
 |
|
| |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Summaries for Patients are a service provided by Annals to help patients better understand the complicated and often mystifying language of modern medicine.
SUMMARIES FOR PATIENTS
Muscle Abnormalities in Four Patients Taking Statins To Treat Unfavorable Cholesterol Levels
1 October 2002 | Volume 137 Issue 7 | Page I-45
Summaries for Patients are presented for informational purposes only. These summaries are not a substitute for advice from your own medical provider. If you have questions about this material, or need medical advice about your own health or situation, please contact your physician. The summaries may be reproduced for not-for-profit educational purposes only. Any other uses must be approved by the American College of Physicians-American Society of Internal Medicine.
The summary below is from the full report titled "Statin-Associated Myopathy with Normal Creatine Kinase Levels." It is in the 1 October 2002 issue of Annals of Internal Medicine (volume 137, pages 581-585). The authors are PS Phillips, RH Haas, S Bannykh, S Hathaway, NL Gray, BJ Kimura, GD Vladutiu, JDF England, and the Scripps Mercy Clinical Research Center.
What is the problem and what is known about it so far?
Statins, also known as HMG coenzyme A reductase inhibitors, are medications commonly used to treat high cholesterol levels. Statins are very effective in getting cholesterol levels into the desired range, and they have had few side effects. However, statins do cause a muscle condition called myopathy. In fact, one statin (cerivastatin) was taken off the market because patients frequently developed myopathy while taking it. Patients with myopathy have muscle tenderness and weakness. Measuring blood levels of the muscle protein called creatine kinase helps doctors to diagnose myopathy because in patients with muscle damage, the protein leaks out of muscle cells and into the blood. Some patients receiving statins develop muscle pain and weakness but have normal serum creatine kinase levels. Doctors have been wondering whether these symptoms represent milder forms of muscle damage related to statins.
Why did the researchers do this particular study?
The researchers report four cases of myopathy associated with statins in patients with normal creatine kinase levels.
Who was studied?
While doing a larger study of muscle symptoms in patients taking statins, the researchers found four patients with muscle pain and weakness during statin therapy that went away when the patients stopped taking the statins. All four patients had normal creatine kinase levels.
How was the study done?
As part of the larger study, the researchers gave the patients statin or placebo and asked the patients to guess which they were taking. The placebo was a pill that looked, smelled, and tasted like statin but contained no active ingredient. All patients had strength testing. In three of the four patients, the doctors took samples of muscle to examine under a microscope (muscle biopsy) both during and after statin therapy.
What did the researchers find?
The patients could correctly guess when they were taking statins because they developed muscle pain and weakness during that therapy. Strength testing showed muscle weakness when the patients were taking statins and normal strength when they were not taking statins. Muscle biopsy samples obtained when patients were taking statins showed changes of myopathy. These changes were not present on the samples taken after the patients stopped statins.
What were the limitations of the study?
This study does not tell us anything about how frequently statin-associated myopathy with normal creatine kinase levels occurs.
What are the implications of the study?
When patients taking statins develop muscle pain and weakness, they may have muscle damage even if blood test results are normal. More research is necessary to learn how frequently patients taking statins develop myopathy with normal creatine kinase levels.
Related articles in Annals:
This article has been cited by other articles:
|
|
 |
|
  S. Sathasivam and B. Lecky Statin induced myopathy BMJ, November 6, 2008; 337(nov06_3): a2286 - a2286. [Full Text]
|
|
|
|
 |
|
 R. Laaksonen, M. T. Janis, and M. Oresic Lipidomics-Based Safety Biomarkers for Lipid-Lowering Treatments Angiology, August 1, 2008; 59(2_suppl): 65S - 68S. [Abstract] [PDF]
|
|
|
|
 |
|
 C. S. Madsen, E. Janovitz, R. Zhang, Van Nguyen-Tran, C. S. Ryan, X. Yin, H. Monshizadegan, M. Chang, C. D'Arienzo, S. Scheer, et al. The Guinea Pig as a Preclinical Model for Demonstrating the Efficacy and Safety of Statins J. Pharmacol. Exp. Ther., February 1, 2008; 324(2): 576 - 586. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. Marcoff and P. D. Thompson The Role of Coenzyme Q10 in Statin-Associated Myopathy: A Systematic Review J. Am. Coll. Cardiol., June 12, 2007; 49(23): 2231 - 2237. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Yokoyama, T. Seo, T. Park, H. Yagyu, Y. Hu, N. H. Son, A. S. Augustus, R. K. Vikramadithyan, R. Ramakrishnan, L. K. Pulawa, et al. Effects of lipoprotein lipase and statins on cholesterol uptake into heart and skeletal muscle J. Lipid Res., March 1, 2007; 48(3): 646 - 655. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. Tsivgoulis, K. Spengos, N. Karandreas, M. Panas, A. Kladi, and P. Manta Presymptomatic neuromuscular disorders disclosed following statin treatment. Arch Intern Med, July 24, 2006; 166(14): 1519 - 1524. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Hansen, E. E. Ferguson, and J. H. Stein Observations From a Statin Myopathy Clinic--Reply Arch Intern Med, June 12, 2006; 166(11): 1233 - 1233. [Full Text] [PDF]
|
|
|
|
|
|
P. S. Phillips and R. H. Haas Observations from a statin myopathy clinic. Arch Intern Med, June 12, 2006; 166(11): 1232 - 1233. [Full Text] [PDF]
|
|
|
|
 |
|
 R. Arora, M. Liebo, and F. Maldonado Statin-Induced Myopathy: The Two Faces of Janus Journal of Cardiovascular Pharmacology and Therapeutics, June 1, 2006; 11(2): 105 - 112. [Abstract] [PDF]
|
|
|
|
 |
|
 J. Kay, D. S. Finn, and J. R. Stone Case 4-2006 -- A 79-Year-Old Woman with Myalgias, Fatigue, and Shortness of Breath N. Engl. J. Med., February 9, 2006; 354(6): 623 - 630. [Full Text] [PDF]
|
|
|
|
 |
|
 F L Mastaglia Drug induced myopathies Practical Neurology, February 1, 2006; 6(1): 4 - 13. [Full Text] [PDF]
|
|
|
|
 |
|
 H. B. Levy and H. K Kohlhaas Considerations for Supplementing with Coenzyme Q10 During Statin Therapy Ann. Pharmacother., February 1, 2006; 40(2): 290 - 294. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. E. Hansen, J. P. Hildebrand, E. E. Ferguson, and J. H. Stein Outcomes in 45 Patients With Statin-Associated Myopathy Arch Intern Med, December 12, 2005; 165(22): 2671 - 2676. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. J. Chapman and A. Carrie Mechanisms of Statin-Induced Myopathy: A Role for the Ubiquitin-Proteasome Pathway? Arterioscler. Thromb. Vasc. Biol., December 1, 2005; 25(12): 2441 - 2444. [Full Text] [PDF]
|
|
|
|
 |
|
 J. L. Seachrist, C.-M. Loi, M. G. Evans, K. A. Criswell, and C. E. Rothwell Roles of Exercise and Pharmacokinetics in Cerivastatin-Induced Skeletal Muscle Toxicity Toxicol. Sci., December 1, 2005; 88(2): 551 - 561. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. L. Urso, P. M. Clarkson, D. Hittel, E. P. Hoffman, and P. D. Thompson Changes in Ubiquitin Proteasome Pathway Gene Expression in Skeletal Muscle With Exercise and Statins Arterioscler. Thromb. Vasc. Biol., December 1, 2005; 25(12): 2560 - 2566. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Chan, R. L Hui, and E. Levin Differential Association Between Statin Exposure and Elevated Levels of Creatine Kinase Ann. Pharmacother., October 1, 2005; 39(10): 1611 - 1615. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B. H. Dobkin Underappreciated Statin-Induced Myopathic Weakness Causes Disability Neurorehabil Neural Repair, September 1, 2005; 19(3): 259 - 263. [Abstract] [PDF]
|
|
|
|
|
|
J. Sacher, L. Weigl, M. Werner, C. Szegedi, and M. Hohenegger Delineation of Myotoxicity Induced by 3-Hydroxy-3-methylglutaryl CoA Reductase Inhibitors in Human Skeletal Muscle Cells J. Pharmacol. Exp. Ther., September 1, 2005; 314(3): 1032 - 1041. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 F. R. Westwood, A. Bigley, K. Randall, A. M. Marsden, and R. C. Scott Statin-Induced Muscle Necrosis in the Rat: Distribution, Development, and Fibre Selectivity Toxicol Pathol, February 1, 2005; 33(2): 246 - 257. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. J. Graham, J. A. Staffa, D. Shatin, S. E. Andrade, S. D. Schech, L. La Grenade, J. H. Gurwitz, K. A. Chan, M. J. Goodman, and R. Platt Incidence of Hospitalized Rhabdomyolysis in Patients Treated With Lipid-Lowering Drugs JAMA, December 1, 2004; 292(21): 2585 - 2590. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. S. Phillips Ezetimibe and Statin-Associated Myopathy Ann Intern Med, October 19, 2004; 141(8): 649 - 649. [Full Text] [PDF]
|
|
|
|
 |
|
 N. J. Stone Stopping Statins Circulation, October 19, 2004; 110(16): 2280 - 2282. [Full Text] [PDF]
|
|
|
|
|
|
C. J. Vaughan and A. M. Gotto Jr Update on Statins: 2003 Circulation, August 17, 2004; 110(7): 886 - 892. [Full Text] [PDF]
|
|
|
|
 |
|
 M. S. Janes, B. J. Hanson, D. M. Hill, G. M. Buller, J. Y. Agnew, S. W. Sherwood, W. G. Cox, K. Yamagata, and R. A. Capaldi Rapid Analysis of Mitochondrial DNA Depletion by Fluorescence In Situ Hybridization and Immunocytochemistry: Potential Strategies for HIV Therapeutic Monitoring J. Histochem. Cytochem., August 1, 2004; 52(8): 1011 - 1018. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Bellosta, R. Paoletti, and A. Corsini Safety of Statins: Focus on Clinical Pharmacokinetics and Drug Interactions Circulation, June 15, 2004; 109(23_suppl_1): III-50 - III-57. [Abstract] [Full Text]
|
|
|
|
|
|
V. Snow, M. D. Aronson, E. R. Hornbake, C. Mottur-Pilson, K. B. Weiss, and the Clinical Efficacy Assessment Subcommittee of t Lipid Control in the Management of Type 2 Diabetes Mellitus: A Clinical Practice Guideline from the American College of Physicians Ann Intern Med, April 20, 2004; 140(8): 644 - 649. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B.A. Golomb, T. Kane, and J.E. Dimsdale Severe irritability associated with statin cholesterol-lowering drugs QJM, April 1, 2004; 97(4): 229 - 235. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. A. Golomb, M. H. Criqui, H. White, and J. E. Dimsdale Conceptual Foundations of the UCSD Statin Study: A Randomized Controlled Trial Assessing the Impact of Statins on Cognition, Behavior, and Biochemistry Arch Intern Med, January 26, 2004; 164(2): 153 - 162. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. D. Thompson, P. Clarkson, and R. H. Karas Issues in Statin-Associated Myopathy--Reply JAMA, August 20, 2003; 290(7): 888 - 889. [Full Text] [PDF]
|
|
|
|
|
|
J. V.L. Sheffield and E. B. Larson Update in General Internal Medicine Ann Intern Med, August 19, 2003; 139(4): 285 - 293. [Full Text] [PDF]
|
|
|
|
|
|
J. W. Anderson Diet First, Then Medication for Hypercholesterolemia JAMA, July 23, 2003; 290(4): 531 - 533. [Full Text] [PDF]
|
|
|
|
|
|
M. H. Hyman Statin-Associated Myopathy with Normal Creatine Kinase Levels Ann Intern Med, June 17, 2003; 138(12): 1007 - 1007. [Full Text] [PDF]
|
|
|
|
|
|
L. E. Teichholz Statin-Associated Myopathy with Normal Creatine Kinase Levels Ann Intern Med, June 17, 2003; 138(12): 1008 - 1008. [Full Text] [PDF]
|
|
|
|
|
|
J. Torgovnick and E. Arsura Statin-Associated Myopathy with Normal Creatine Kinase Levels Ann Intern Med, June 17, 2003; 138(12): 1007 - 1007. [Full Text] [PDF]
|
|
|
|
|
|
E. Toma and M. Loignon Statin-Associated Myopathy with Normal Creatine Kinase Levels Ann Intern Med, June 17, 2003; 138(12): 1007 - 1008. [Full Text] [PDF]
|
|
|
|
 |
|
 R. A. Kreisberg and A. Oberman Medical Management of Hyperlipidemia/Dyslipidemia J. Clin. Endocrinol. Metab., June 1, 2003; 88(6): 2445 - 2461. [Full Text] [PDF]
|
|
|
|
|
|
P. D. Thompson, P. Clarkson, and R. H. Karas Statin-Associated Myopathy JAMA, April 2, 2003; 289(13): 1681 - 1690. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
W. E. Bennett, A. J. Drake III, and K. M. Shakir Reversible Myopathy after Statin Therapy in Patients with Normal Creatine Kinase Levels Ann Intern Med, March 4, 2003; 138(5): 436 - 437. [Full Text] [PDF]
|
|
|
|
 |
|
 I. Malik JournalScan Heart, January 1, 2003; 89(1): 119 - 120. [Full Text] [PDF]
|
|
|
|
 |
|
 Insights About Statin-Related Muscle Aches Journal Watch Cardiology, November 22, 2002; 2002(1122): 4 - 4. [Full Text]
|
|
|
|
 |
|
 Statin-Related Myopathy with Normal CK Levels Journal Watch (General), November 1, 2002; 2002(1101): 2 - 2. [Full Text]
|
|
|
|
|
|
S. M. Grundy Can Statins Cause Chronic Low-Grade Myopathy? Ann Intern Med, October 1, 2002; 137(7): 617 - 618. [Full Text] [PDF]
|
|
| |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Article
