Statins & Muscle Problems ( It's more common than you might think)

Muscle problems are the most common reported adverse effects of
statins, according to an observational database maintained by the
University of California at San Diego Statin Study group. Perhaps the
most feared adverse effect of statins is rhabdomyolysis--a condition
in which there is severe breakdown of muscle tissue that may be toxic
to the kidneys and result in kidney failure or death. The muscle
breakdown commonly leads to a strong elevation in blood levels of
muscle enzyme creatine kinase (CK). Creatine kinase levels often
exceed 10 times the upper limit of normal in cases of frank
rhabdomyolysis. Fatal rhabdomyolysis occurred with increased frequency
with cerivastatin (Baycol) when used at higher doses or in combination
with gemfibrozil (Lopid); cerivastatin was removed from the U.S.
market in 2001. Rhabdomyolysis occurs with all statins, although the
actual frequency of occurrence is quite low.
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Physicians are most familiar with rhabdomyolysis, and many suppose
that for muscle pain to be statin-associated, it must induce muscle
symptoms throughout the body coupled with elevation of CK levels.
However, this reflects only one manifestation of statin-associated
muscle symptoms. Some patients have only new focal pain or new
fatigue, and may have mild or no elevation in CK levels. In some
instances these symptoms progress to rhabdomyolysis--one reason to
take these symptoms seriously--but many times they do not.

An important double-blind, crossover biopsy study showed that some
patients receiving statin therapy with non-CK-elevating muscle pain
have objectively documentable, partially reversible mitochondrial
myopathy (Phillips et al., 2002). Even in the absence of
rhabdomyolysis or CK elevation, major effects on function and quality
of life may occur (Golomb et al., 2003). It is important to note that
in both our experience and that of others, muscle symptoms
precipitated by statins may not in all cases completely recover; this
is consistent with the finding that, pathologically, the myopathy may
not completely reverse.
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Adverse muscle problems from statins, in addition to rhabdomyolysis,
take a variety of forms (Table). Shortness of breath sometimes
accompanies statin-associated muscle problems. The "respiratory
exchange ratio"--the ratio of carbon dioxide exhaled per oxygen
inhaled--is altered in people with statin myotoxicity (Phillips et
al., 2004). Occasionally, shortness of breath is the predominant
symptom. Patients may experience marked shortness of breath that
occurs following initiation of statin therapy and is sustained while
statins are continued for which no etiology is identified on extensive
cardiopulmonary workup. These symptoms resolve completely with statin
discontinuation.
Muscle problems associated with statins may be more common among the
elderly. In the 2002 American College of Cardiology/American Heart
Association/National Heart, Lung, and Blood Institute Clinical
Advisory on the Use and Safety of Statins, Pasternak et al. noted the
following factors that may increase the risk for statin-associated
myopathy:  | Back to Top |

• advanced age;
• small body frame and frailty;
• multisystem disease;
• multiple medications;
• perioperative periods; and
• concurrent use of certain medications.

These factors are especially common among the elderly, which places
them at increased risk for development of muscle problems with
statins.
Muscle problems associated with statins may be more debilitating among
the elderly. When muscle problems occur, they may have more impact on
the elderly. Elderly patients more commonly have already declined in
muscle strength and function; and are often already on, or perched
near, the steep part of the curve relating muscle strength to physical
function, independence and the ability to perform activities of daily
living. Thus, the same amount or proportion of compromise in muscle
function may have a substantially more profound impact on quality of
life in elderly patients. In addition, reductions in physical
function, indexed by reductions in lower extremity function, are
linked to self-reported disability, hospitalizations, admissions to
nursing homes and mortality from all causes (Guralnik et al., 2000,
1995, 1994; Penninx et al., 2000). Reductions in lower extremity
function are associated with reduced physical activity (McDermott et
al., 2002), so that such patients may lose the protection that
exercise is reported to afford against a host of conditions. | Back to Top |

Wishing you all the best of health and a long & happy life.

Sincerely

Norman And Brenda Rose

Provided by Beatrice A. Golomb, M.D., PH.D

www.thehormoneshop.com 

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Norman@thehormoneshop.com
This page was last updated on 11/07/11

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