by Charles Sorbie, MB, ChB, FRCS(E), FRCS(C)
High cholesterol’s deadly risk to the heart makes it worth putting up with aching muscles for the effects of statin therapy.
Myalgia affecting one or several muscle groups occurs in 5% to 10% of patients taking statins to lower their cholesterol. Statins (3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors) vary in their propensity to cause myalgia, myopathy, and rhabdomyolysis. While myalgia can be bad enough to discourage strict adherence to cholesterol reduction therapy, rhabdomyolysis can be deadly.
T.A. Jacobson (Mayo Clin Proc. 2008; 83[6]:687-700) presents a clinical algorithm for the diagnosis and management of myalgia. Adherence to a painful regime for the treatment of painless but potentially dangerous high cholesterol requires dedication. Jacobson notes some telling figures that should keep patients’ lipid-lowering noses to the grindstone: Myalgia affects 5% to 10% of patients on statins, myopathy affects 0.1%, and the often-fatal rhabdomyolysis affects 0.01%. Its mortality risk is 0.3% per 100,000 person-years of statin therapy, but the survival benefit of statins in patients with coronary artery disease yields 360 lives saved per 100,000 person-years.
Fluvastatin appears to have some advantages over other statins, especially in those patients with other risk factors for myalgia and myopathy: physical activity, trauma, hypothyroidism, infections, carbon monoxide poisoning, poly- and dermatomyositis, and alcohol and drug abuse. Creatin kinase level is a good warning sign for muscle toxicity and should be checked before treatment commences and if muscle symptoms develop. If the muscle aches and pains are bad enough, there are alternatives to statins.
Short-term pain for long-term gain—yet again.
Blue Notes Editor:
Charles Sorbie, MB, ChB, FRCS(E), FRCS(C)
Dr. Charles Sorbie is Professor of Surgery at Queen’s University and a member of the Attending Staff at the General and Hotel Dieu Hospitals in Kingston, Ontario.A former chairman of the Department of Surgery at Queen’s University, Dr. Sorbie has been President of the Canadian Orthopaedic Research Society, the Canadian Orthopaedic Association, and the Societé Internationale de Chirurgie Orthopédique et de Traumatologie (SICOT).
