Vitamin D deficiency, myositis–myalgia, and reversible statin intolerance

Abstract

Objective:

In 150 hypercholesterolemic patients, unable to tolerate ≥1 statin because of myositis-myalgia, selected by low (<32 ng/ml) serum 25 (OH) vitamin D, we prospectively assessed whether vitamin D supplementation with resolution of vitamin D deficiency would result in statin tolerance, free of myositis–myalgia.

Research design and methods:

We studied 74 men, 76 women, median age 60, 131 white, 17 black and 2 other. On no statins, 50,000 units of vitamin D was given twice a week for 3 weeks, and then continued once a week. After 3 weeks on vitamin D, statins were restarted. Patients were re-assessed on statins and vitamin D every 3 to 4 months, with serial measures of serum 25 (OH) vitamin D, creatine phosphokinase (CPK), LDL cholesterol (LDLC) and assessment of myositis–myalgia.

Main outcome measures:

Percentage of patients myalgia-free on vitamin D plus reinstituted statins, serum 25 (OH) vitamin D, CPK, and LDLC on reinstituted statins and concurrent vitamin D supplementation.

Results:

On vitamin D supplementation plus re-instituted statins for a median of 8.1 months, 131 of the 150 patients (87%) were free of myositis–myalgia and tolerated the statins well. Serum 25 (OH) vitamin D increased from median 21 to 40 ng/ml (p < 0.001), and normalized (≥32 ng/ml) in 117 (78%) of 150 previously vitamin D deficient, statin-intolerant patients. Median LDLC decreased from 146 mg/dl to 95 mg/dl, p < 0.001.

Conclusion:

Symptomatic myositis–myalgia in hypercholesterolemic statin-treated patients with concurrent serum 25 (OH) vitamin D deficiency may reflect a reversible interaction between vitamin D deficiency and statins on skeletal muscle causing myalgia.

Key words::

• Hypercholesterolemia
• Myositis–myalgia
• Serum 25 (OH) vitamin D deficiency
• Statins

Transparency

Declaration of funding

This paper is supported in part by the Lipoprotein Research Fund and the Medical Research Funds of the Jewish Hospital of Cincinnati. All authors contributed to the literature review, data collection, data entry, data analysis and editing of the final article.

Declaration of financial/other relationships

C.J.G., S.B.B., S.S.M., C.A., N.K., P.W., and N.G. have disclosed that they have no significant relationships with or financial interests in any commercial companies related to this study or article.