ACE inhibitors, statins and thiazides: no association with change in grip strength among community dwelling older men and women from the Hertfordshire Cohort Study

Renin angiotensin system-induced muscle wasting: putative mechanisms and implications for clinicians

Renin angiotensin system (RAS) alters various mechanisms related to muscle wasting. The RAS system consists of classical and non-classical pathways, which mostly function differently. Classical RAS pathway, operates through angiotensin II (AngII) and angiotensin type 1 receptors, is associated with muscle wasting and sarcopenia. On the other hand, the non-classical RAS pathway, which operates through angiotensin 1-7 and Mas receptor, is protective against sarcopenia. The classical RAS pathway might induce muscle wasting by variety of mechanisms. AngII reduces body weight, via reduction in food intake, possibly by decreasing hypothalamic expression of orexin and neuropeptide Y, insulin like growth factor-1 (IGF-1) and mammalian target of rapamycin (mTOR), signaling, AngII increases skeletal muscle proteolysis by forkhead box transcription factors (FOXO), caspase activation and muscle RING-finger protein-1 transcription. Furthermore, AngII infusion in skeletal muscle reduces phospho-Bad (Ser136) expression and induces apoptosis through increased cytochrome c release and DNA fragmentation. Additionally, Renin angiotensin system activation through AT1R and AngII stimulates tumor necrosis factor-α, and interleukin-6 which induces muscle wasting, Last but not least classical RAS pathway, induce oxidative stress, disturb mitochondrial energy metabolism, and muscle satellite cells which all lead to muscle wasting and decrease muscle regeneration. On the contrary, the non-classical RAS pathway functions oppositely to mitigate these mechanisms and protects against muscle wasting. In this review, we summarize the mechanisms of RAS-induced muscle wasting and putative implications for clinical practice. We also emphasize the areas of uncertainties and suggest potential research areas.

Is sarcopenia an associated factor of increased administration of specific medications in patients with heart failure? A systematic review and meta-analysis

Background

There is controversy in relation to commonly used drugs in heart failure (HF) and their impact on muscle function. The aim of this study was to evaluate the odds of receiving specific medications often used in clinical practice by patients with HF and sarcopenia vs. without sarcopenia.

Methods

A systematic literature search of cohort studies via databases (PubMed, Web of Science, Scopus, and Cochrane Library) was conducted from inception until March 2023. To determine if sarcopenia is linked to a higher number of specific HF-related medications, a meta-analysis using a random-effects model was used to calculate the pooled effects.

Results

Our main analyses showed no significant association of sarcopenia with administration of higher HF-related medication count vs. those without sarcopenia. Those with lower appendicular lean mass (ALM) had significantly lower odds of receiving angiotensin converting enzyme inhibitors (ACE-Is)/angiotensin receptor blockers (ARBs) (OR: 0.68, 95%CI 0.50-0.90, I2 = 12%, P < 0.01) vs. patients with higher ALM for which age could be an important confounder based on meta-regression. No statistically significant differences were found in relation to B-blockers OR: 0.84, 95%CI 0.63-1.12, I2 = 7%, P = 0.24) and loop diuretics (OR: 1.19, 95%CI 0.87-1.63, I2 = 0%, P = 0.27). Regarding handgrip strength, gait speed, and short physical performance battery, our narrative synthesis found mixed results.

Conclusion

This systematic review and meta-analysis did not find a relationship of specific medication count in sarcopenia vs. without sarcopenia in patients with HF, although increased odds of ACE-I/ARB was shown in those with higher ALM.

Systematic Review Registration

PROSPERO (CRD42023411137).

Novel Potential Targets for Function-Promoting Therapies: Orphan Nuclear Receptors, Anti-inflammatory Drugs, Troponin Activators, Mas Receptor Agonists, and Urolithin A

In recent years, several new classes of therapies have been investigated with their potential for restoring or improving physical functioning in older adults. These have included Mas receptor agonists, regulators of mitophagy, skeletal muscle troponin activators, anti-inflammatory compounds, and targets of orphan nuclear receptors. The present article summarizes recent developments of the function-promoting effects of these exciting new compounds and shares relevant preclinical and clinical data related to their safety and efficacy. The development of novel compounds in this area is expanding and likely will need the advent of a new treatment paradigm for age-associated mobility loss and disability.

Mini-review: Angiotensin- converting enzyme 1 (ACE1) and the impact for diseases such as Alzheimer's disease, sarcopenia, cancer, and COVID-19

Ageing has been associated with comorbidities, systemic low-grade of inflammation, and immunosenescence. Hypertension is the most common morbidity and anti-hypertensives are used for more than 50%. Angiotensin-converting enzyme 1 inhibitors (ACEi) and angiotensin II receptor blockers (ARB) control blood pressure but also seem to play a role in comorbidities such as Alzheimer's disease, sarcopenia and cancer. The impact of anti-hypertensives in comorbidities is due to the expression of renin-angiotensin system (RAS) in several tissues and body fluids. Angiotensin-converting enzyme 1 (ACE1) has been linked to oxidative stress, metabolism, and inflammation. The levels and activity of ACE1 are under genetic control and polymorphisms have been correlated with susceptibility to Alzheimer's disease. In addition, some results found that ACEi and ARB users present delayed cognitive decline and reduced risk of dementia. Regarding to sarcopenia, RAS has been linked to the catabolic and anabolic pathways for muscle mass maintenance. In some studies, older adults using ACEi were highly benefited by exercise training. In cancer, RAS and its products have been shown to play a role since their inhibition in animal models modulates tumor microenvironment and improves the delivery of chemotherapy drugs. Clinically, the incidence of colorectal cancer is reduced in patients using ACEi and ARB. During the pandemic COVID-19 it was found that ACE2 receptor plays a role in the entry of SARS-CoV-2 into the host cell. ACE1 genotypes have been linked to an increased risk for COVID-19 and severe disease. In some studies COVID-19 patients taking ARB or ACEi presented better outcome.

Insights into Pathogenesis, Nutritional and Drug Approach in Sarcopenia: A Systematic Review

Sarcopenia is a multifactorial condition related to the loss of muscle mass and strength due to aging, eating habits, physical inactivity, or even caused by another disease. Affected individuals have a higher risk of falls and may be associated with heart disease, respiratory diseases, cognitive impairment, and consequently an increased risk of hospitalization, in addition to causing an economic impact due to the high cost of care during the stay in hospitals. The standardization of appropriate treatment for patients with sarcopenia that could help reduce pathology-related morbidity is necessary. For these reasons, this study aimed to perform a systematic review of the role of nutrition and drugs that could ameliorate the health and quality of life of sarcopenic patients and PRISMA guidelines were followed. Lifestyle interventions have shown a profound impact on sarcopenia treatment but using supplements and different drugs can also impact skeletal muscle maintenance. Creatine, leucine, branched-chain amino acids, omega 3, and vitamin D can show benefits. Although with controversial results, medications such as Metformin, GLP-1, losartan, statin, growth hormone, and dipeptidyl peptidase 4 inhibitors have also been considered and can alter the sarcopenic's metabolic parameters, protect against cardiovascular diseases and outcomes, while protecting muscles.

Genome-Wide Analysis in Drosophila Reveals the Genetic Basis of Variation in Age-Specific Physical Performance and Response to ACE Inhibition

Despite impressive results in restoring physical performance in rodent models, treatment with renin–angiotensin system (RAS) inhibitors, such as Lisinopril, have highly mixed results in humans, likely, in part, due to genetic variation in human populations. To date, the genetic determinants of responses to drugs, such as RAS inhibitors, remain unknown. Given the complexity of the relationship between physical traits and genetic background, genomic studies which predict genotype- and age-specific responses to drug treatments in humans or vertebrate animals are difficult. Here, using 126 genetically distinct lines of Drosophila melanogaster, we tested the effects of Lisinopril on age-specific climbing speed and endurance. Our data show that functional response and sensitivity to Lisinopril treatment ranges from significant protection against physical decline to increased weakness depending on genotype and age. Furthermore, genome-wide analyses led to identification of evolutionarily conserved genes in the WNT signaling pathway as being significantly associated with variations in physical performance traits and sensitivity to Lisinopril treatment. Genetic knockdown of genes in the WNT signaling pathway, Axin, frizzled, nemo, and wingless, diminished or abolished the effects of Lisinopril treatment on climbing speed traits. Our results implicate these genes as contributors to the genotype- and age-specific effects of Lisinopril treatment and because they have orthologs in humans, they are potential therapeutic targets for improvement of resiliency. Our approach should be widely applicable for identifying genomic variants that predict age- and sex-dependent responses to any type of pharmaceutical treatment.

Quadriceps muscle power and optimal shortening velocity are inversely related to angiotensin converting enzyme activity in older men

Background: Methods which potentially could prevent age-related loss of muscle mass and function are still being sought. There are various attempts to use pharmacological agents to prevent loss of muscle mass, but the effectiveness of many of them still needs to be confirmed. One of the promising therapeutics are Angiotensin Converting Enzyme Inhibitors (ACEIs) and lowering of serum ACE activity. The goal of this study was to assess if taking Angiotensin Converting Enzyme Inhibitors (ACEI) and other angiotensin system blocking medications (ASBMs) can modify muscle performance in older men as well as to assess the association of serum ACE activity with muscle strength, power, muscle contraction velocity and functional performance. Methods: Seventy-nine older men took part in the study. Muscle function was assessed with hand grip strength, maximum power relative to body mass (Pmax) and optimal shortening velocity (Ʋopt) of the knee extensor muscles. Anthropometric data, ACE activity and functional performance were also measured. Results: Negative correlations between ACE activity and Pmax (rho=-0.29, p=0.04) as well as Ʋopt  (rho=-0.31, p=0.03) in a group of patients not taking ACEI and between ACE activity and Ʋopt (rho=-0.22, p=0.05) in the whole group of men were found. Positive relationship between age and ACE activity was demonstrated (rho=0.26, p=0.02). Age was the only selected variable in the multiple regression analyses to determine both Pmax and Ʋopt. Conclusions: Serum ACE activity negatively associates to muscle power and muscle contraction velocity. The issues related to the impact of taking ACEI on the maintenance of muscle function and functional performance in older man require further studies.

Quadriceps muscle power and optimal shortening velocity are inversely related to angiotensin converting enzyme activity in older men

Background: Methods which potentially could prevent age-related loss of muscle mass and function are still being sought. There are various attempts to use pharmacological agents to prevent loss of muscle mass, but the effectiveness of many of them still needs to be confirmed. One of the promising therapeutics are Angiotensin Converting Enzyme Inhibitors (ACEIs) and lowering of serum ACE activity. The goal of this study was to assess if taking Angiotensin Converting Enzyme Inhibitors (ACEI) and other angiotensin system blocking medications (ASBMs) can modify muscle performance in older men as well as to assess the association of serum ACE activity with muscle strength, power, muscle contraction velocity and functional performance. Methods: Seventy-nine older men took part in the study. Muscle function was assessed with hand grip strength, maximum power relative to body mass (Pmax) and optimal shortening velocity (Ʋopt) of the knee extensor muscles. Anthropometric data, ACE activity and functional performance were also measured. Results: Negative correlations between ACE activity and Pmax (rho=-0.29, p=0.04) as well as Ʋopt  (rho=-0.31, p=0.03) in a group of patients not taking ACEI and between ACE activity and Ʋopt (rho=-0.22, p=0.05) in the whole group of men were found. Positive relationship between age and ACE activity was demonstrated (rho=0.26, p=0.02). Age was the only selected variable in the multiple regression analyses to determine both Pmax and Ʋopt. Conclusions: Taking ACEI is not associated with a functional performance in older men of the same age and with the same anthropometric parameters. Serum ACE activity negatively associates to muscle power and muscle contraction velocity.

Effect of Angiotensin System Inhibitors on Physical Performance in Older People - A Systematic Review and Meta-Analysis

Objective

Preclinical and observational data suggest that angiotensin converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARBs) may be able to improve physical performance in older people via direct and indirect effects on skeletal muscle. We aimed to summarize current evidence from randomised controlled trials in this area.

Design

Systematic review and meta-analysis.

Setting and Participants

Randomized controlled trials enrolling older people, comparing ACEi or ARB to placebo, usual care or another antihypertensive agent, with outcome data on measures of physical performance.

Methods

We searched multiple electronic databases without language restriction between inception and the end of February 2020. Trials were excluded if the mean age of participants was <65 years or treatment was targeting specific diseases known to affect muscle function (for example heart failure). Data were sought on measures of endurance and strength. Standardized mean difference (SMD) treatment effects were calculated using random-effects models with RevMan software.

Results

Eight trials (952 participants) were included. Six trials tested ACEi, 2 trials tested ARBs. The mean age of participants ranged from 66 to 79 years, and the duration of treatment ranged from 2 months to 1 year. Trials recruited healthy older people and people with functional impairment; no trials specifically targeted older people with sarcopenia. Risk of bias for all trials was low to moderate. No significant effect was seen on endurance outcomes [6 trials, SMD 0.04 (95% CI –0.22 to 0.29); P = .77; I² = 53%], strength outcomes [6 trials, SMD –0.02 (95% CI –0.18 to 0.14), P = .83, I² = 21%] or the short physical performance battery [3 trials, SMD –0.04 (95% CI –0.19 to 0.11), P = .60, I² = 0%]. No evidence of publication bias was evident on inspection of funnel plots.

Conclusions and Implications

Existing evidence does not support the use of ACE inhibitors or angiotensin receptor blockers as a single intervention to improve physical performance in older people.

Association between Statin Use and Physical Function among Older Chinese Inpatients with Type 2 Diabetes

PURPOSE

Multiple statin-associated muscle symptoms (SAMS) risk factors usually coexist in a given older diabetic patient, but the association between statin use and physical function in older Asian persons with T2MD remains uncertain. The present study therefore sought to provide insight into this uncertainty through a focused assessment of statin-associated outcomes in Chinese diabetic adults.

DESIGN

Cross-sectional study.

SETTINGS AND PARTICIPANTS

The study included 146 participants with T2MD in the Center of Gerontology and Geriatric, West China Hospital.

MEASUREMENTS

The participants received the comprehensive geriatric assessment (CGA). Statin use and other medical data for each patient were determined via assessment of the inpatient hospital information system. Assessments of physical functions included ADLs, IADLs and the Timed "Up and Go" (TUG) test. Multiple regression analyses were then performed in order to determine the relationship between statin utilization and physical function.

RESULTS

The average age of these 146 participants (32 women, 21.9%) was 80.00±5.60 years. At enrollment, 78 (53.4%) of the 146 patients were treated with statins. Among the statin users, 48.7% presented with a lack of TUG ability, which was significantly greater than in non-statin users (27.9%). However, the rates of IADL and ADL disabilities did not differ significantly between groups. In a multiple regression analyses, statin use was associated with a three-fold (95% CI 1.06, 9.51) increase in the risk of TUG inability, after adjusted all covariates.

CONCLUSIONS

There was a significant association between statin use and TUG inability in older Chinese inpatients with diabetes.

The Hertfordshire Cohort Study: an overview

The Hertfordshire Cohort Study is a nationally unique study of men and women born in the English county of Hertfordshire in the early part of the 20 ^th century. Records that detail their health in infancy and childhood have been preserved, their sociodemographic, lifestyle, medical and biological attributes have been characterised in later life, and routinely collected data on their hospital use and mortality have been acquired. This paper provides an overview of the study since its inception in the 1980s, including its methods, findings, and plans for its future.

Associations between ACE-Inhibitors, Angiotensin Receptor Blockers, and Lean Body Mass in Community Dwelling Older Women

Studies suggest that ACE-inhibitors (ACE-I) and angiotensin receptor blockers (ARBs) may preserve skeletal muscle with aging. We evaluated longitudinal differences in lean body mass (LBM) among women diagnosed with hypertension and classified as ACE-I/ARB users and nonusers among Women's Health Initiative participants that received dual energy X-ray absorptiometry scans to estimate body composition (n=10,635) at baseline and at years 3 and 6 of follow-up. Of those, 2642 were treated for hypertension at baseline. Multivariate linear regression models, adjusted for relevant demographics, behaviors, and medications, assessed ACE-I/ARB use/nonuse and LBM associations at baseline, as well as change in LBM over 3 and 6 years. Although BMI did not differ by ACE-I/ARB use, LBM (%) was significantly higher in ACE-I/ARB users versus nonusers at baseline (52.2% versus 51.3%, resp., p=0.001). There was no association between ACE-I/ARB usage and change in LBM over time. Reasons for higher LBM with ACE-I/ARB use cross sectionally, but not longitundinally, are unclear and may reflect a threshold effect of these medications on LBM that is attenuated over time. Nevertheless, ACE-I/ARB use does not appear to negatively impact LBM in the long term.

Relationship of quadriceps muscle power and optimal shortening velocity with angiotensin-converting enzyme activity in older women

BACKGROUND

The goal of this study was to assess whether angiotensin-converting enzyme (ACE) activity is related to muscle function (strength, power and velocity), as well as to assess if ACE inhibitors (ACEIs) and other angiotensin system blocking medications (ASBMs) influence muscle performance in elderly women.

SUBJECTS AND METHODS

Ninety-five community-dwelling elderly women took part in this study. Anthropometric data, blood ACE activity analysis, maximum power (Pmax) and optimal shortening velocity (υopt) of the knee extensor muscles, handgrip strength, physical activity (PA) and functional performance were measured.

RESULTS

Women taking ACEI were on average almost 2 years older than the women who did not take ACEI. They took more medicines and were also characterized by significantly lower level of ACE, but they did not differ in terms of PA level, results of functional performance and parameters characterizing muscle functions. No correlations of ACE activity with Pmax and handgrip strength, as well as with PA or functional performance were found. Higher ACE activity was connected with lower υopt for women who did not take any ASBMs (rho =-0.37; p=0.01).

CONCLUSION

Serum ACE activity was not associated with muscle strength, power and functional performance in both ASBM users and nonusers, but was associated with optimal shortening velocity of quadriceps muscles in older women. Further prospective studies are needed to assess if ACEIs or other ASBMs may slow down the decline in muscle function and performance.

Associations of statin use with motor performance and myalgia may be modified by 25-hydroxyvitamin D: findings from a British birth cohort

The objective was to examine whether: (1) statin use was associated with muscle related outcomes at age 60-64, (2) these associations were modified by 25-hydroxyvitamin D (25(OH)D) status and explained by inflammation, body-size or lifestyle in a British birth cohort. Markers of myalgia (intrusive body pain) and myopathy (self-reported and performance-based measures) were examined in 734 men and 822 women (MRC National Survey of Health and Development). Statin use was associated with intrusive body pain, difficulty climbing stairs and slower chair rise speed. Some associations were modified by 25(OH)D e.g. the association with intrusive body pain was evident in the insufficient (13-20 ng/l) and deficient (<13 ng/l) 25(OH)D status groups (OR = 2.6,95% CI 1.7-1.1; OR = 1.8,95% CI 1.2-2.8, respectively) but not in those with status >20 ng/l (OR = 0.8,95% CI 0.5-1.4) (p = 0.003 for interaction). Associations were maintained in fully adjusted models of intrusive body pain and difficulty climbing stairs, but for chair rise speed they were fully accounted for by inflammation, body-size and lifestyle. In a nationally representative British population in early old age, statin use was associated with lower limb muscle-related outcomes, and some were only apparent in those with 25(OH)D status below 20 ng/l. Given 25(OH)D is modifiable in clinical practice, future studies should consider the links between 25(OH)D status and muscle related outcomes.

The Effects of Medication on Activity and Rehabilitation of Older People – Opportunities and Risks

Multiple medication use, or polypharmacy, is common in people undergoing rehabilitation. Polypharmacy is also common in older people, where it has the potential to impact on habitual physical activity. Despite this, the interactions between medication, disease, activity, and rehabilitation outcomes are insufficiently researched. In this review, we consider common classes of medications that can affect physical activity levels and outcomes of rehabilitation. We consider medications that improve disease processes and improve limiting symptoms (eg, breathlessness in heart failure and lung disease, pain in arthritis), unwanted side effects of medications (eg, central slowing caused by opioids and hypnotics), and also medication classes that might have the ability to improve activity and rehabilitation outcomes via beneficial effects on neuromuscular function (eg, angiotensin-converting enzyme inhibitors). We conclude by giving practical advice on how to review and optimise medication use to support habitual physical activity and ensure the best results from rehabilitation.

Sarcopenia is associated with severe liver fibrosis in patients with non-alcoholic fatty liver disease

BACKGROUND

Sarcopenia recognises insulin resistance and obesity as risk factors, and is frequently associated with cardiometabolic disorders, including non-alcoholic fatty liver disease (NAFLD).

AIM

To test the prevalence of sarcopenia and its relation with the severity of fibrosis (main outcome) and the entire spectrum of liver histology in patients with NAFLD.

METHODS

We considered 225 consecutive patients with histological diagnosis of NAFLD (Kleiner score). The skeletal muscle index (%) (total appendicular skeletal muscle mass (kg)/weight (kg) × 100), a validated measure of sarcopenia, was assessed by bioelectrical impedance analysis. Sarcopenia was defined as a skeletal muscle mass index ≤37 in males and ≤28 in females.

RESULTS

The prevalence of sarcopenia showed a linear increase with the severity of fibrosis, and severe fibrosis (F3-F4) was more than doubled in sarcopenia (48.3% vs. 20.4% in fibrosis ≤F2, P < 0.001). After adjusting for confounders, the association of sarcopenia with severe fibrosis was maintained (OR 2.36, CI 1.16-4.77, P = 0.01), together with age > 50 (OR 6.53, CI 2.95-14.4, P < 0.001), IFG/Diabetes (OR 2.14, CI 1.05-4.35, P = 0.03) and NASH (OR 13.3, CI 1.64-108.1, P = 0.01). Similarly, a significant association was found between sarcopenia and NASH (P = 0.01), steatosis severity (P = 0.006), and ballooning (P = 0.01), but only the association with severe steatosis was maintained (OR 2.02, CI 1.06-3.83, P = 0.03) after adjusting for confounders.

CONCLUSIONS

In Western patients with NAFLD, with high prevalence of metabolic disorders and advanced liver disease, sarcopenia was associated with the severity of fibrosis and steatosis, independently of hepatic and metabolic risk factors. Studies are needed to assess the impact of interventions to reduce sarcopenia on NAFLD progression.

Effect of Angiotensin-Converting Enzyme Inhibitors on Physical Function in Elderly Subjects: A Systematic Review and Meta-Analysis

BACKGROUND

Sarcopenia has been accepted as a new geriatric syndrome, which will become a common and important public health challenge. And angiotensin-converting enzyme inhibitors (ACEIs) have been shown to improve exercise capacity in elderly without heart failure.

OBJECTIVES

To evaluate the effect of angiotensin-converting enzyme inhibitors (ACEIs) on physical function in elderly.

DATA SOURCES

The Cochrane Library, PubMed, EMBASE and Web of Science were searched.

ELIGIBILITY CRITERIA

All researches included were randomized controlled trials (RCTs) which compared any kind of ACEIs with placebo or other anti-hypertensives in elderly, and provided empirical data of grip strength and 6-min walk distance change from baseline.

STUDY APPRAISAL AND SYNTHESIS METHODS

Risk of bias was systematically assessed by using the Cochrane risk of bias tool. Data of grip strength and 6-min walk distance change from baseline were collected and mean differences (MDs) were calculated along with 95% CI (confidence interval) by using a random effects model.

RESULTS

In 3 RCTs including 337 elderly participants, ACEIs (n = 178) did not significantly improved 6-min walk distance (13.45, 95% CI: -16.71 to 43.61; P = 0.38) versus placebo or other antihypertensives (n = 159). In 3 RCTs including 499 elderly participants, grip strength was not significantly different (-0.67, 95% CI: -1.53 to 0.19; P = 0.12) between ACEIs (n = 260) and placebo or other antihypertensives (n = 239).

LIMITATIONS

There exists only 4 RCTs and the number of participants is limited. Pooling of data were from different trials including different participant characteristics. And intervention is not strictly consistent.

CONCLUSION

This study shows that ACEIs can not significantly improve walk distance or the age-related decline of muscle strength for older participants in clinical trials.

Muscle-related side-effects of statins: from mechanisms to evidence-based solutions

PURPOSE OF REVIEW

This article highlights the recent findings regarding statin-associated muscle side effects, including mechanisms and treatment as well as the need for more comprehensive clinical trials in statin myalgia.

RECENT FINDINGS

Statin myalgia is difficult to diagnose and treat, as major clinical trials have not routinely assessed muscle side-effects, there are few clinically relevant biomarkers and assessment tools for the symptoms, many apparent statin-related muscle symptoms may be nonspecific and related to other drugs or health conditions, and prevalence estimates vary widely. Data thus suggest that only 30-50% of patients with self-reported statin myalgia actually experience muscle pain on statins during blinded, placebo-controlled trials. In addition, evidence to date involving mechanisms underlying statin myalgia and its range of symptoms and presentations supports the hypothesis that there are multiple, interactive and potentially additive mechanisms underlying statin-associated muscle side-effects.

SUMMARY

There are likely multiple and interactive mechanisms underlying statin myalgia, and recent studies have produced equivocal data regarding prevalence of statin-associated muscle side-effects, contributing factors and effectiveness of common interventions. Therefore, more clinical trials on statin myalgia are critical to the field, as are systematic resources for quantifying, predicting and reporting statin-associated muscle side-effects.