Narrative Review: Statin-Related Myopathy

doi:10.1059/0003-4819-150-12-200906160-00009

Narrative Review: Statin-Related Myopathy

Tisha R. Joy, MD; and
Robert A. Hegele, MD

From Robarts Research Institute and Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada.

Abstract

Statin-related myopathy is a clinically important cause of statin intolerance and discontinuation. The spectrum of statin-related myopathy ranges from common but clinically benign myalgia to rare but life-threatening rhabdomyolysis. Observational studies suggest that myalgia can occur in up to 10% of persons prescribed statins, whereas rhabdomyolysis continues to be rare. The mechanisms of statin-related myopathy are unclear. Options for managing statin myopathy include statin switching, particularly to fluvastatin or low-dose rosuvastatin; nondaily dosing regimens; nonstatin alternatives, such as ezetimibe and bile acid–binding resins; and coenzyme Q10 supplementation. Few of these strategies have high-quality evidence supporting them. Because statin-related myopathy will probably become more common with greater numbers of persons starting high-dose statin therapy and the increasing stringency of low-density lipoprotein cholesterol level targets, research to better identify patients at risk for statin myopathy and to evaluate management strategies for statin-related myopathy is warranted.

Article and Author Information

Grant Support: By the Jacob J. Wolfe Distinguished Medical Research Chair; the Edith Schulich Vinet Canada Research Chair (Tier I) in Human Genetics; a Career Investigator award from the Heart and Stroke Foundation of Ontario (CI-5710); and operating grants from the Canadian Institutes for Health Research (MOP-13430, MOP-39533, MOP-39833), Heart and Stroke Foundation of Ontario (PRG-5967, NA-6059, T-6018), Ontario Research Fund, and Genome Canada through the Ontario Genomics Institute.
Potential Financial Conflicts of Interest: Consultancies: R.A. Hegele (Merck-Schering, Merck Frosst, AstraZeneca, Genzyme). Honoraria: T.R. Joy (Merck Frosst, Merck-Schering), R.A. Hegele (Merck-Schering, Merck Frosst, Pfizer, AstraZeneca, Oryx, Solvay, Boehringer Ingelheim, Biovail). Grants received: R.A. Hegele (Merck-Schering, Pfizer Canada, Schering-Plough, AstraZeneca).
Requests for Single Reprints: Tisha R. Joy, MD, Division of Endocrinology, Schulich School of Medicine and Dentistry, St. Joseph's Health Care, A2-117, 268 Grosvenor Street, London, N6A 4V2 Ontario, Canada; e-mail, tisjoy{at}hotmail.com.
Current Author Addresses: Dr. Joy: Division of Endocrinology, Schulich School of Medicine and Dentistry, St. Joseph's Health Care, A2-117, 268 Grosvenor Street, London, N6A 4V2 Ontario, Canada.
Dr. Hegele: Robarts Research Institute, 406-100 Perth Drive, London, N6A 5K8 Ontario, Canada.

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