Iranian Heart Journal

Iranian Heart Journal

Unveiling Barriers and Investigating the Influence of High-Intensity Therapy on Statin-Induced Myalgia and Intolerance

Document Type : Original Article

Authors
Dileep Kumar 1
Umamah Yasin 1
Kamran Ahmed Khan 1
Fawaz Bardowli 2
Shahzad Khatti 1
Tahir Saghir 1
Jawaid Akbar Sial 1
Maryam Saeed 1
Atiqa Amir Ali 1
Reeta Bai 3
Ayan Ahmed Khan 4
Nadeem Qamar 1
1 National Institute of Cardiovascular Diseases, Karachi, Pakistan.
2 Mohammed Bin Khalifa Specialist Cardiac Centre, Bahrain.
3 Jinnah Medical and Dental College, Karachi, Pakistan.
4 Foundation Public School, Karachi, Pakistan.
Abstract
Background: We used the statin-associated muscle symptom clinical index (SAMS-CI) to evaluate misconceptions among cardiologists regarding the use of high-intensity statins (HIS) in relation to intolerance, including myalgia, and to determine the occurrence of HIS-induced myalgia in patients with acute coronary syndrome (ACS).
 
Methods: The present observational cohort study, performed in a tertiary care cardiac hospital in Karachi, Pakistan, consisted of 2 phases. Phase 1 involved an online survey among practicing cardiologists to identify obstacles to HIS prescription. The second phase involved observing 418 ACS patients who underwent HIS therapy. Myalgia was assessed using the SAMS-CI and categorized as unlikely (2–6), possible (7–8), or probable (9–11) cases of myalgia.
 
Results: In the first phase, 77.8% (35/45) of physicians favored prescribing HIS therapy. However, the commonly perceived barriers were myalgia (31%), tolerability (29%), and affordability (22%). In the second phase, 418 patients were included. Among them, 19 patients (4.54%) experienced muscle symptoms based on the SAMS-CI score. Subsequently, 5 patients were classified as unlikely and continued the same dosage, while 6 patients were categorized as possible, leading to a reduction in dosage to moderate intensity. Consequently, their symptoms were resolved, and they continued the moderate-intensity regimen. Statin use was discontinued for the remaining 8 patients in the probable category for 4 weeks until the symptoms resolved, after which moderate-intensity statins were resumed.
 
Conclusions: Most patients tolerated a lower targeted dose of HIS without experiencing objective symptoms. Therefore, we confidently conclude that a lower targeted dose of HIS is generally well tolerated in the ACS setting and should be considered by physicians. (Iranian Heart Journal 2024; 25(2): 47-55)
Keywords
Acute coronary syndrome
High-intensity statin
Intolerance
Myalgia
SAMS-CI
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Iranian Heart Journal
Volume 25, Issue 2
Spring 2024
Pages 47-55