Neurológia pre prax 6/2013

Statins and myopathy

Statins are the most effective and widely used drugs to reduce low-density lipoprotein cholesterol and reduce cardiovascular events. 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, serum creatine kinase elevations, muscle weakness, necrotizing myopathy including recently discovered immune-mediated statin-associated necrotizing myopathy and at present very rare rhabdomyolysis. The risk of statin- associated myopathy can be minimized by identifying vulnerable risk patients and/or by eliminating statin interactions with specific drugs. Management of statin-intolerant patients depends on the severity of myopathic symptoms and signs and levels of serum creatine kinase. Options for managing mild myopathies include statin switching, particularly to fluvastatin or lowdose rosuvastatin and nondaily dosing regimens. In sever myopathies and significantly increase creatine kinase levels treatment with statins must be discontinued.

Keywords: statin-related myopathy, statin intolerance, necrotizing myopathy, management of statin myopathies.