Diagnostic and therapeutic approach to muscle symptoms induced by statins

Abstract

Statins are the most frequently used pharmacological group of lipid-lowering agents worldwide. A significant reduction in cardiovascular risk in patients with atherosclerosis has been linked to statin use in primary and secondary prevention.

However, over time, multiple adverse effects related to its use have been reported, estimated to range from 1.5% to 20% of cases, depending on the literature consulted. A large group compassing different spectrums of adverse effects is called muscular symptoms associated with statins. These have been frequently reported and constitute a risk for the abandonment of pharmacological therapy. In most cases, these effects are dose-dependent and can encompass different clinical presentations, including myalgias, myositis, creatine kinase (CK) elevation, myopathy, myositis, and myonecrosis. Due to this problem, multiple investigations have been carried out, and many theories have been proposed to identify the mechanisms involved in some patients after using statins. However, so far, these theories have yet to be demonstrated.

What is clear is that certain risk factors increase the probability that patients develop these symptoms, such as concomitant use with fibrates, macrolides, or the type of statin used. There are no clear guidelines for managing statin-induced myopathies; however, it is essential to recognize the symptoms and determine if there is an association between the symptoms and the use of these drugs to eventually make clinical decisions that may impact the patients' lives who use them.