An overview of statin-induced myopathy and perspectives for the future

ABSTRACT

Introduction: Statins remain the most commonly prescribed lipid-lowering drug class for the treatment of atherosclerotic cardiovascular disease. Their well-recognized side effects are known as statin-associated muscle symptom (SAMS). Some advances in this field have been made in recent years, but the understanding of the mechanisms has lagged. Investigating the specific role of the anti-HMGCR autoantibody, pharmacokinetic genetic variants, characterization of the known phenotypes of statin toxicity, in relation to clinical markers of disease, is of high importance.

Areas covered: We summarized currently available findings (on PubMed) related to SAMS and discussed the therapeutic approaches, risk factors, drug interactions, potential novel systems, algorithms and biomarkers for SAMS detection. CoQ10 supplementation has been suggested as a complementary approach to manage SAMS, while vitamin D levels may be useful for both the diagnosis and management.

Expert Opinion/Commentary: Further studies might help to understand the easiest way to diagnose SAMS, suitable prevention and an effective non-statin therapy. This review sheds new light on the future directions in both research and clinical practice, which will help with rapid risk assessment, identification of the SAMS risk factors in order to decrease the incidence of statins’ adverse effects, and the most effective therapy.

KEYWORDS:

• Coenzyme Q10
• drug interactions
• myositis autoantibodies
• risk factors
• statin-induced myopathy
• statin-associated muscle symptoms
• therapeutic approaches
• underlying mechanisms

Article Highlights

• Statin-associated muscle symptoms (SAMS) represents a spectrum of disorders from myalgia to rhabdomyolysis associated to statin therapy discontinuation.

• The underlying pathophysiology and mechanisms remain not fully understood.

• Genetic predispositions, subjects’ personal and family histories, including co-existing disorders/risk factors, as well as drug interactions should be carefully considered by clinicians.

• The use of novel algorithms as well as biomarkers could prevent and/or reduce the incidence of SAMS, including vitamin D supplementation.

• The risk assessment and diagnosis of SAMS will improve in the next five years, while future genetic research could lead to a personalized therapeutic approach.

This box summarizes key points contained in the article.

Declaration of interest

Dragana Nikolic has attended conferences and participated in trials sponsored by various pharmaceutical companies. Maciej Banach has given talks, attended conferences and participated in advisory boards and trials sponsored by various pharmaceutical companies. Roberta Chianetta has attended conferences and participated in trials sponsored by various pharmaceutical companies. Anca Pantea Stoian has given talks, attended conferences and participated in advisory boards and trials sponsored by various pharmaceutical companies. She is currently Vice President of Romanian National Diabetes Committee. Camelia Cristina Diaconu has given talks, attended conferences and participated in advisory boards and trials sponsored by various pharmaceutical companies. Roberto Citarrella has given talks, attended conferences and participated in trials sponsored by various pharmaceutical companies. Giuseppe Montallo has given talks, attended conferences and participated in advisory boards and trials sponsored by various pharmaceutical companies. Manfredi Rizzo has given talks, attended conferences and participated in advisory boards and trials sponsored by various pharmaceutical companies. He is currently Director, Clinical Medical & Regulatory Department, Novo Nordisk Europe East and South.

Reviewer disclosures

One peer reviewer has disclosed they hold a patent for anti-HMGCR autoantibody detection and receive royalties from Inova Diagnostics. Another peer review has disclosed they hold intellectual property on HMGCR testing (Inova diagnostics). Other peer reviewers on this manuscript have no other relevant financial relationships or otherwise to disclose.

Additional information

Funding

This paper was not funded.