Low Vitamin D as a Risk Factor for the Development of Myalgia in Patients Taking High-Dose Simvastatin: A Retrospective Review

• Published in: Clinical therapeutics Vol. 36; no. 5; pp. 770 - 777
• Main Authors: Mergenhagen, Kari, PharmD, BCPS AQ-ID, Ott, Michael, PharmD, BCPS, Heckman, Kerry, PharmD, Rubin, Lisa M., PharmD, Kellick, Kenneth, PharmD, CLS
• Format: Journal Article
• Language: English
• Published: Bridgewater, NJ Elsevier Inc 01.05.2014; Elsevier; Elsevier Limited
• Subjects: Adult; Aged; Alcoholism; Biological and medical sciences; Body mass index; Cardiovascular disease; Diabetes; Diseases of striated muscles. Neuromuscular diseases; Dose-Response Relationship, Drug; Drug therapy; Humans; Hypothyroidism; Internal Medicine; Kidney diseases; Laboratories; Logistic Models; Male; Medical Education; Medical Records; Medical sciences; Middle Aged; muscle pain; Muscular Diseases - chemically induced; myalgia; Myalgia - blood; Myalgia - chemically induced; myopathy; Neurology; Patients; Pharmacology. Drug treatments; Potassium; Retrospective Studies; rhabdomyolysis; Rhabdomyolysis - chemically induced; Risk Factors; simvastatin; Simvastatin - administration & dosage; Simvastatin - adverse effects; Statins; Triglycerides; Veterans; Vitamin B; Vitamin D; Vitamin D - blood; Vitamin D Deficiency - complications; Young Adult; United States > US; muscle pain; rhabdomyolysis; myalgia; myopathy; statins; vitamin D; simvastatin; Human; Enzyme; Simvastatin; Enzyme inhibitor; Statin derivative; Myalgia; Rhabdomyolysis; Hypocholesterolemic agent; Epidemiology; Retinol; Striated muscle disease; Pain; Vitamin D; Follow up study; HMG-CoA reductase inhibitor; Risk factor; Hydroxymethylglutaryl-CoA reductase; Muscle; Oxidoreductases; High dose; Antilipemic agent; Myopathy
• ISSN: 0149-2918; 1879-114X
• DOI: 10.1016/j.clinthera.2014.02.023

Abstract Background Statins are the treatment of choice for dyslipidemia, primarily lowering elevated LDL-C levels and reducing the occurrence of major cardiovascular events. In June 2011, the Food and Drug Administration issued a warning regarding the use of high-dose simvastatin 80 mg and its risk of myopathy. Objective The incidence of myalgia, myopathy, and rhabdomyolysis was analyzed in a veteran population prescribed simvastatin 80 mg. Risk factors for myalgia were examined and compared with the results of recently published studies. Methods This was a retrospective medical record review of 450 patients who were prescribed simvastatin 80 mg at the Veterans Affairs Western New York Healthcare System between August 1, 2006, and July 31, 2011. Records were examined for evidence of myalgia, myopathy (incipient or definite), and rhabdomyolysis. Variables that may have contributed to the development of myalgia were also collected and analyzed. Results Myalgia was reported by 50 patients (11.1%), whereas rhabdomyolysis developed in 1 patient (0.22%). No patient fit the criteria for myopathy (incipient or definite). Myalgia was statistically more likely to occur in younger patients, patients with a history of myalgia, and patients with low vitamin D levels. The mean (SD) vitamin D level in patients experiencing myalgia was 26.2 (12.9) versus 36.3 (11.8) ng/mL. The 25-hydroxyvitamin D level in those who reported myalgia was approximately 10 ng/mL lower compared with those who tolerated simvastatin 80 mg ( P = 0.0003). There was no statistically significant association between length of therapy and development of myalgia. Conclusion A lower incidence of adverse muscle events with high-dose simvastatin 80 mg was found in patients with higher vitamin D levels, suggesting that correction of 25-hydroxyvitamin D levels before statin therapy initiation may mitigate one risk factor in the development of statin-related myalgia. Vitamin D insufficiency appears to be a risk factor for the development of myalgia.