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Warden BA, Guyton JR, Kovacs AC, Durham JA, Jones LK, Dixon DL, Jacobson TA, Duell PB. Assessment and management of statin-associated muscle symptoms (SAMS): A clinical perspective from the National Lipid Association. J Clin Lipidol 2023; 17:19-39. [PMID: 36115813 DOI: 10.1016/j.jacl.2022.09.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Statin-associated muscle symptoms (SAMS) are the most common form of statin intolerance and are associated with increased risk of cardiovascular events that manifest from statin underutilization and discontinuation. The reported frequencies of SAMS are divergent in the literature. The writing group estimates the prevalence of SAMS, namely all muscle symptoms temporally related to statin use but without regard to causality, to be about 10% (range 5% to 25%), and the prevalence of pharmacological SAMS, specifically muscle symptoms resulting from pharmacological properties of the statin, to be about 1-2% (range 0.5% to 4%). In clinical practice, SAMS are likely to result from a combination of pharmacological and nonpharmacological effects, however this does not make the symptoms any less clinically relevant. Regardless of the etiology, SAMS need to be addressed in accordance with patients' preferences and experiences. This clinical perspective reviews the epidemiology and underlying pathophysiology of SAMS, and the cardiovascular consequences resulting from statin discontinuation. We present patient-centered clinical and communication strategies to mitigate SAMS and improve medication adherence and outcomes among statin users. Treatment strategies include 1) optimizing lifestyle interventions, 2) modulating risk factors that may contribute to muscle symptoms, 3) optimizing statin tolerability by dose reduction, decreased dosing frequency, or use of an alternate statin with more favorable pharmacokinetic properties, and 4) use of non-statins, emphasizing those with evidence for atherosclerotic risk reduction, either in combination with or in place of statin therapy depending on the patient's circumstances. The focus of this clinical perspective is sustainable lipoprotein goal achievement, which is important for cardiovascular risk reduction.
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Affiliation(s)
- Bruce A Warden
- Center for Preventive Cardiology, Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR, USA (Dr Warden), (Dr. Duell).
| | - John R Guyton
- Duke University Medical Center, Durham, NC, USA (Dr Guyton).
| | - Adrienne C Kovacs
- CPsych, Equilibria Psychological Health, Toronto, ON, Canada (Dr Kovacs).
| | | | - Laney K Jones
- Genomic Medicine Institute, Geisinger; Danville, PA, USA (Dr Jones).
| | - Dave L Dixon
- Department of Pharmacotherapy & Outcomes Science, Virginia Commonwealth University School of Pharmacy, Richmond, VA, United States (Dr Dixon).
| | - Terry A Jacobson
- Department of Medicine, Lipid Clinic and CVD Risk Reduction Program, Emory University School of Medicine, Atlanta, GA, United States (Dr Jacobson).
| | - P Barton Duell
- Center for Preventive Cardiology, Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR, USA (Dr Warden), (Dr. Duell); Division of Endocrinology, Diabetes, and Clinical Nutrition, Oregon Health & Science University, Portland, OR.
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Peersen K, Munkhaugen J, Sverre E, Kristiansen O, Fagerland M, Vethe NT, Perk J, Husebye E, Dammen T. Clinical and psychological factors in coronary heart disease patients with statin associated muscle side-effects. BMC Cardiovasc Disord 2021; 21:596. [PMID: 34915854 PMCID: PMC8680044 DOI: 10.1186/s12872-021-02422-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 12/06/2021] [Indexed: 11/10/2022] Open
Abstract
Background To compare clinical and psychological factors among patients with self-perceived statin-associated muscle symptoms (SAMS), confirmed SAMS, and refuted SAMS in coronary heart disease patients (CHD). Methods Data were obtained from a cross-sectional study of 1100 CHD outpatients and a study of 71 CHD outpatients attending a randomized, double-blinded, placebo-controlled, crossover study to test effects of atorvastatin 40 mg/day on muscle symptom intensity. Clinical and psychosocial factors were compared between patients with and without SAMS in the cross-sectional study, and between patients with confirmed SAMS and refuted SAMS in the randomized study. Results Bilateral, symmetric muscle symptoms in the lower extremities during statin treatment were more prevalent in patients with confirmed SAMS compared to patients with refuted SAMS (75% vs. 41%, p = 0.01) in the randomized study. No significant differences in psychological factors (anxiety, depression, worry, insomnia, type D personality characteristics) were detected between patients with and without self-perceived SAMS in the cross-sectional study, or between patients with confirmed SAMS and refuted SAMS, in the randomized study. Conclusions Patients with confirmed SAMS more often present with bilateral lower muscle symptoms compared to those with refuted SAMS. Psychological factors were not associated with self-perceived SAMS or confirmed SAMS. A careful pain history and a search for alternative causes of muscle symptoms are likely to promote communication in patients with SAMS, and may reduce the risk for statin discontinuation.
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Affiliation(s)
- Kari Peersen
- Department of Medicine, Vestfold Hospital Trust, Tønsberg, Norway. .,Department of Behavioral Medicine and Faculty of Medicine, University of Oslo, Oslo, Norway.
| | - John Munkhaugen
- Department of Behavioral Medicine and Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Medicine, Drammen Hospital, Drammen, Norway
| | - Elise Sverre
- Department of Behavioral Medicine and Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Medicine, Drammen Hospital, Drammen, Norway
| | | | - Morten Fagerland
- Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway
| | - Nils Tore Vethe
- Department of Pharmacology, Oslo University Hospital, Oslo, Norway
| | - Joep Perk
- Faculty of Health Sciences, Linnaeus University, Kalmar, Sweden
| | - Einar Husebye
- Department of Medicine, Drammen Hospital, Drammen, Norway
| | - Toril Dammen
- Department of Behavioral Medicine and Faculty of Medicine, University of Oslo, Oslo, Norway
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The comparative effects of high dose atorvastatin and proprotein convertase subtilisin/kexin type 9 inhibitor on the mitochondria of oxidative muscle fibers in obese-insulin resistant female rats. Toxicol Appl Pharmacol 2019; 382:114741. [PMID: 31473249 DOI: 10.1016/j.taap.2019.114741] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Revised: 08/06/2019] [Accepted: 08/28/2019] [Indexed: 12/23/2022]
Abstract
The present study aimed to compare the effects of high dose atorvastatin and a proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitor on the mitochondrial function in oxidative muscle fibers in obese female rats. Female Wistar rats were fed with either a normal diet (ND: n = 12) or a high-fat diet (HFD: n = 36) for a total of 15 weeks. At week 13, ND-fed rats received a vehicle, and HFD-fed rats were divided to three groups to receive either a vehicle, 40 mg/kg/day of atorvastatin, or 4 mg/kg/day of PCSK9 inhibitor (SBC-115076) for 3 weeks. Soleus muscles were investigated to assess mitochondrial ROS, membrane potential, swelling, mitochondrial-related protein expression, and level of malondialdehyde (MDA). The results showed that HFD-fed rats with vehicle developed obese-insulin resistance and dyslipidemia. Both atorvastatin and PCSK9 inhibitor reduced obesity and dyslipidemia, as well as improved insulin sensitivity in HFD-fed rats. However, the efficacy of PCSK9 inhibitor to increase weight loss and reduce dyslipidemia in HFD-fed rats was greater than those of atorvastatin. An increase in MDA level, ratio of p-Drp1ser616/total Drp1 protein, CPT1 protein, mitochondrial ROS, and membrane depolarization in the soleus muscle were observed in HFD-fed rats with vehicle. PCSK9 inhibitor enabled the restoration of all these parameters to normal levels. However, atorvastatin facilitated restoration of some parameters, including MDA level, p-Drp1ser616/total Drp1 ratio, and CPT1 protein expression. These findings suggest that PCSK9 inhibitor is superior to atorvastatin in instigating weight loss, cholesterol reduction, and attenuation of mitochondrial oxidative stress in oxidative muscle fibers of obese female rats.
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Munkhaugen J, Vethe NT, Fagerland MW, Dammen T, Perk J, Gjertsen E, Otterstad JE, Gullestad L, Bergan S, Husebye E. Statin-associated muscle symptoms in coronary patients: design of a randomized study. SCAND CARDIOVASC J 2019; 53:162-168. [DOI: 10.1080/14017431.2019.1612085] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- John Munkhaugen
- Department of Medicine, Drammen Hospital, Vestre Viken Trust, Drammen, Norway
- Department of Behavioural Science in Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Nils Tore Vethe
- Department of Pharmacology, Oslo University Hospital, Oslo, Norway
| | - Morten Wang Fagerland
- Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway
| | - Toril Dammen
- Department of Behavioural Science in Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Joep Perk
- Institute of Health and Caring Sciences, Linneus University, Kalmar, Sweden
| | - Erik Gjertsen
- Department of Medicine, Drammen Hospital, Vestre Viken Trust, Drammen, Norway
| | | | - Lars Gullestad
- Department of Cardiology, Oslo University Hospital, Oslo, Norway
| | - Stein Bergan
- Department of Pharmacology, Oslo University Hospital, Oslo, Norway
- School of Pharmacy, University of Oslo, Oslo, Norway
| | - Einar Husebye
- Department of Medicine, Drammen Hospital, Vestre Viken Trust, Drammen, Norway
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