Statin-associated muscle symptoms (
SAMS) are one of the principal reasons for
statin non-adherence and/or discontinuation, contributing to adverse cardiovascular outcomes. This European
Atherosclerosis Society (EAS) Consensus Panel overviews current understanding of the pathophysiology of
statin-associated
myopathy, and provides guidance for diagnosis and management of
SAMS.
Statin-associated
myopathy, with significant elevation of serum
creatine kinase (CK), is a rare but serious side effect of
statins, affecting 1 per 1000 to 1 per 10 000 people on standard
statin doses.
Statin-associated muscle symptoms cover a broader range of clinical presentations, usually with normal or minimally elevated CK levels, with a prevalence of 7-29% in registries and observational studies. Preclinical studies show that
statins decrease mitochondrial function, attenuate energy production, and alter
muscle protein degradation, thereby providing a potential link between
statins and muscle symptoms; controlled mechanistic and genetic studies in humans are necessary to further understanding. The Panel proposes to identify
SAMS by symptoms typical of
statin myalgia (i.e.
muscle pain or aching) and their temporal association with discontinuation and response to repetitive
statin re-challenge. In people with
SAMS, the Panel recommends the use of a maximally tolerated
statin dose combined with non-
statin lipid-lowering
therapies to attain recommended
low-density lipoprotein cholesterol targets. The Panel recommends a structured work-up to identify individuals with clinically relevant
SAMS generally to at least three different
statins, so that they can be offered therapeutic regimens to satisfactorily address their cardiovascular risk. Further research into the underlying pathophysiological mechanisms may offer future therapeutic potential.