Recommendations from others
A 2002 Clinical Advisory, jointly issued by the American College of Cardiology, the American Heart Association, and the National Heart, Lung and Blood Institute, asserted that statins carry a small but definite myopathy risk.1 It recommended against routine creatine kinase tests, reserving them for patients who develop muscle symptoms. It also recommended stopping statins when muscle symptoms with creatine kinase elevations >10 times the upper limits of normal occur, with consideration of restarting statins later at a lower dose if symptoms and elevated creatine kinase resolve. Careful monitoring of patients at higher risk of statin myopathy is also recommended.
CLINICAL COMMENTARY
Benefits of statins outweigh the risks
Joseph Saseen, PharmD, BCPS
University of Colorado Health Sciences Center, Denver
Contrary to popular belief, statin-associated myopathy is a rare adverse event. Drug-drug interactions and comorbid diseases (especially chronic kidney disease) increase myopathy risk. Given the overwhelming evidence demonstrating reduced morbidity and mortality with statins, benefits outweigh risks in patients with elevated low-density lipoprotein cholesterol. Data supporting myopathy management strategies are limited, but support stopping statin therapy in patients with myopathy (muscle aches/pain with elevated creatine kinase), and restarting, possibly with a different statin, after symptoms resolve. Myopathy should not be confused with myalgia (muscle aches/pain with normal creatine kinase). Myalgia requires interrupting treatment only for patients with persistent muscle aches/pain while on statin therapy.