Any region 1.33 (1.06-1.67) 0.96 (0.81-1.15) Neck/upper back 0.88 (0.53-1.45) 0.81 (0.61-1.08) Upper extremities 0.82 (0.49-1.35) 0.84 (0.62-1.15) Lower back 1.47 (1.02-2.13) 1.05 (0.81-1.37) Lower extremities 1.59 (1.12-2.22) 0.96 (0.76-1.22) *Adjusted :age, sex, race, smoking, self-reported health, CHD, DM, cancer, Sys BP, BMI, TC,ABI Buettner et al American Journal of Medicine (2012) 125, 176-182 Statin use was associated with a higher prevalence of musculoskeletal pain in the lower extremities, among individuals without arthritis Body Region W/O Arthritis (n=5170) W/ Arthritis (n=3058) Prevalence of Statin Use on Self Reported Musculoskeletal Pain: NHANES
Risk Factors for Statin Intolerance: Patient-related Patient Advanced age (>80) Female sex Low BMI Multisystem disease (particularly liver, kidney, or both) Hypothyroidism (untreated) Excess Alcohol Grapefruit or Cranberry juice consumption (_1 qt/d) Vigorous activity Major surgery or trauma Intercurrent infections History of myopathy on another lipid-lowering therapy History of creatine kinase elevation Unexplained cramps Family history of myopathy on lipid-lowering therapy Family history of myopathy (polymorphisms of P450 isoenzymes or drug transporters, inherited defects of muscle metabolism, traits that affect oxidative metabolism of fatty acids)
Differential Diagnosis of Myopathy or Creatine Kinase Elevations Not Due to Lipid-Lowering Therapy Muscle symptoms Physical exertion (deconditioned) Viral illness Vitamin D deficiency Hypo- or hyperthyroidism Cushing syndrome or adrenal insuffic Hypoparathyroidism Fibromyalgia Polymyalgia rheumatica Polymyositis Systemic lupus erythematosus Tendon or joint disorder Trauma Seizures or severe chills Peripheral arterial disease Medications Glucocorticoids Antipsychotics Antiretroviral drugs Illicit drugs (cocaine or amphetamines) Creatine kinase elevations Physical exertion Hypothyroidism Metabolic or inflammatory myopathies Alcoholism Neuropathy or radiculopathy Ethnicity (black Americans may have elevated baseline creatine kinase levels) Idiopathic hyperCKemia Seizure or severe chills Trauma Medications Illicit drugs (cocaine or amphetamines) Antipsychotics For patients who present with cramping in their calves or thighs. Refers to elevated creatine kinase level without another cause identified
Routine monitoring of liver enzymes in the blood is no longer needed FDA Advisory : Statins Feb 28, 2012 People being treated with statins may have an increased risk of raised blood sugar levels and the development of Type 2 diabetes Some medications interact with lovastatin and can increase the risk of muscle damage. Cognitive impairment ( memory loss, forgetfulness and confusion) has been reported by some statin users
Shepardson et al Arch Neurol. 2011 Nov;68(11):1385-92. Cholesterol level and statin use in Alzheimer disease Blood-Brain Barrier Permeability of Major Statins NamePermeability LovastatinYes PravastatinNo FluvastatinNo SimvastatinYes AtorvastatinDisputed CerivastatinDisputed RosuvastatinNo
Statin Use and Risk of DM in Postmenopausal Women in the Women's Health Initiative Culver et al Statin Use and Risk of Diabetes Mellitus in Postmenopausal Women in the Women's Health Initiative Arch Intern Med. 2012;172(2):144-152.
Are Statins Associated with Dementia ? Statin Ever User Statin Never User Beydoun et al J Epidemiol Community Health 2011;65:949-957 doi:10.1136/jech.2009.100826 Ageing Research report Statins and serum cholesterol's associations with incident dementia and mild cognitive impairment Dementia-free survival probability