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

Document Type : Original Article

Authors

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

References

  1. Tomaszewski M, Stępień K, Tomaszewska J, Czuczwar S. Statin-induced myopathies. Pharmacol Rep 2011; 63(4):859-66. https://doi.org/10.1016/s1734-1140(11)70601-6
  2. Stancu C, Sima A. Statins: mechanism of action and effects. J Cell Mol Med 2001; 5(4):378-87.https://doi.org/10.1111/j.1582-4934.2001.tb00172.x
  3. Baigent C, Keech A, Kearney PM, Blackwell L, Buck G, Pollicino C, et al. Efficacy and safety of cholesterol-lowering treatment: prospective meta-analysis of data from 90,056 participants in 14 randomised trials of statins. Lancet 2005; 366(9493):1267-78. https://doi.org/10.1016/s0140-6736(05)67394-1
  4. Stroes ES, Thompson PD, Corsini A, Vladutiu GD, Raal FJ, et al. Statin-associated muscle symptoms: impact on statin therapy-European Atherosclerosis Society Consensus Panel Statement on Assessment, Aetiology and Management. Eur Heart J 2015; 36(17):1012–22. https://doi.org/10.1093/eurheartj/ehv043
  5. Law M, Rudnicka AR. Statin safety: a systematic review. Am J Cardiol. 2006; 97(8A):52-60C. https://doi.org/10.1016/j.amjcard.2005.12.010
  6. Bays H. Statin safety: an overview and assessment of the data—2005. Am J Cardiol 2006;97(8):S6-26. https://doi.org/10.1016/j.amjcard.2005.12.006
  7. Bruckert E, Hayem G, Dejager S, Yau C, Bégaud B. Mild to Moderate Muscular Symptoms With High-Dosage Statin Therapy in Hyperlipidemic Patients--The PRIMO Study. Cardiovasc Drugs Ther 2005;19(6):403-14. https://doi.org/10.1007/s10557-005-5686-z
  8. Scott RS, Lintott CJ, Wilson MJ. Simvastatin and side effects. New Zealand Med J 1991; 104(924):493-5. https://pubmed.ncbi.nlm.nih.gov/1745460/
  9. Abd T, Jacobson T. Statin-induced myopathy: a review and update. Expert Opin Drug Saf 2011; 10(3):373-87. https://doi.org/10.1517/14740338.2011.540568
  10. Chodick G, Shalev V, Gerber Y, Heymann AD, Silber H, Simah V, et al. Long-term persistence with statin treatment in a not-for-profit health maintenance organization: A population-based retrospective cohort study in Israel. Clin Ther 2008; 30(11):2167-79. https://doi.org/10.1016/j.clinthera.2008.11.012
  11. Laufs U, Scharnagl H, März W. Statin intolerance. Curr Opin Lipidol 2015; 26(6):492-501. https://doi.org/10.1097/mol.0000000000000236
  12. Naito R, Miyauchi K, Daida H. Racial Differences in the Cholesterol-Lowering Effect of Statin. J Atheroscler Thromb 2017; 24(1):19-25. https://doi.org/10.5551/jat.rv16004
  13. Tomlnson B, Chan P, Liu ZM. Statin Responses in Chinese Patients. J Atheroscler Thromb 2018; 25(2):199-202. https://doi.org/10.5551/jat.40204
  14. Rosenson R. Current overview of statin-induced myopathy. Am J Med 2004; 116(6):408-16. https://doi.org/10.1016/j.amjmed.2003.10.033
  15. Stein EA, Davidson MH, Dobs AS, Schrott H, Dujovne CA, Bays H, et al. Efficacy and safety of simvastatin 80 mg/day in hypercholesterolemic patients. Am J Cardiol 1998;82(3):311-6. https://doi.org/10.1016/s0002-9149(98)00421-4
  16. Bakker-Arkema RG, Nawrocki JW, Black DM. Safety profile of atorvastatin-treated patients with low LDL-cholesterol levels. Atherosclerosis 2000; 149(1):123-9. https://doi.org/10.1016/s0021-9150(99)00294-4
  17. Pasternak RC, Smith Jr SC, Bairey-Merz CN, Grundy SM, Cleeman JI, Lenfant C. ACC/AHA/NHLBI clinical advisory on statins. Stroke 2002; 33(9):2337-41. https://doi.org/10.1161/01.str.0000034125.94759.41
  18. Parker B, Capizzi J, Grimaldi A, Clarkson PM, Cole SM, Keadle J, et al. Effect of Statins on Skeletal Muscle Function. Circulation 2013; 127(1):96-103. https://doi.org/10.1161/circulationaha.112.136101
  19. Skilving I, Eriksson M, Rane A, Ovesjö M. Statin-induced myopathy in a usual care setting—a prospective observational study of gender differences. Eur J Clinic Pharmacol 2016; 72(10):1171-1176. https://doi.org/10.1007/s00228-016-2105-2
  20. Barter P. High- Versus Low-Dose Statin. Circulation 2018; 137(19):2013-15. https://doi.org/10.1161/circulationaha.118.034407
Iranian Heart Journal
Volume 25, Issue 2
March 2024
Pages 47-55

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