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Can Statins Cause Chronic Low-Grade Myopathy?
- Scott M. Grundy, MD, PhD
Statins (hydroxymethyl glutaryl coenzyme A reductase inhibitors) are highly effective drugs for reducing serum cholesterol and low-density lipoprotein cholesterol levels. Clinical trials have shown that they also reduce risk for coronary heart disease events, coronary procedures, and stroke by about one third (1). Millions of people in the United States and worldwide are being treated with statins. In clinical trials and in clinical practice, statins have proved to be remarkably safe.
The one notable side effect of statin therapy is myopathy. A small fraction of patients who are treated with statins will develop severe myopathy (2). In the worst cases, severe myoglobinuria, acute renal failure, and even death can occur. The incidence of severe myopathy is low, perhaps 1 in 1000 patients (2). Predisposing factors for severe myopathy appear to include advanced age, relatively low body weight, female sex, certain medications, use of multiple medications, multisystem disease, and acute illnesses or major surgery (3). If statins were avoided or used in low doses in these circumstances, it is likely that the incidence of severe myopathy could be greatly reduced.
Less severe forms of myopathy undoubtedly occur. In some patients, fatigue and muscle pain and weakness develop with moderately high serum creatine kinase levels but not acute renal failure. In these cases, the myopathy resolves …
