Abstract
There is no clearly defined clinical presentation of statin-associated muscle symptoms (SAMS) because there is no objective test to verify the presence of SAMS. Experts agree that many more patients complain of statin-associated symptoms than have these symptoms demonstrated in blinded clinical trials or during placebo–statin, crossover studies designed to verify SAMS. Consequently, any description of the clinical presentation of SAMS depends primarily on expert opinion. Also, the clinical presentation of SAMS varies widely from mild myalgia to life-threatening rhabdomyolysis. The most frequent SAMS is myalgia which often occurs soon after statin onset, affects large muscle groups, is usually symmetric on both sides of the body, is not necessarily associated with increases in creatine kinase (CK), resolves promptly with statin cessation and reappears with statin re-initiation. Many patients present with convincing symptoms that vary from this classical description, however. Consequently, the primary approach to determining if muscle symptoms are SAMS is cessation and re-initiation of the statin. This approach is compromised by the “nocebo effect” or the patient’s expectation that the intervention will produce harm. This chapter summarizes the variable clinical presentation of SAMS.
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References
Rosenson RS, Baker SK, Jacobson TA, Kopecky SL, Parker BA, The National Lipid Association’s Muscle Safety Expert Panel. An assessment by the statin muscle safety task force: 2014 update. J Clin Lipidol. 2014;8(3 Suppl):S58–71. https://doi.org/10.1016/j.jacl.2014.03.004.
Mancini GB, Baker S, Bergeron J, et al. Diagnosis, prevention, and management of statin adverse effects and intolerance: Canadian consensus working group update (2016). Can J Cardiol. 2016;32(7 Suppl):S35–65. https://doi.org/10.1016/j.cjca.2016.01.003.
Stroes ES, Thompson PD, Corsini A, 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.
Ganga HV, Slim HB, Thompson PD. A systematic review of statin-induced muscle problems in clinical trials. Am Heart J. 2014;168(1):6–15. https://doi.org/10.1016/j.ahj.2014.03.019.
Sorokin AV, Duncan B, Panetta R, Thompson PD. Rhabdomyolysis associated with pomegranate juice consumption. Am J Cardiol. 2006;98(5):705–6. S0002-9149(06)01006-X [pii].
Clarkson PM, Kearns AK, Rouzier P, Rubin R, Thompson PD. Serum creatine kinase levels and renal function measures in exertional muscle damage. Med Sci Sports Exerc. 2006;38(4):623–7. https://doi.org/10.1249/01.mss.0000210192.49210.fc.
Knochel JP. Catastrophic medical events with exhaustive exercise: “White collar rhabdomyolysis”. Kidney Int. 1990;38(4):709–19. S0085-2538(15)57008-7 [pii].
Mammen AL. Statin-associated autoimmune myopathy. N Engl J Med. 2016;374(7):664–9. https://doi.org/10.1056/NEJMra1515161.
Christopher-Stine L, Casciola-Rosen LA, Hong G, Chung T, Corse AM, Mammen AL. A novel autoantibody recognizing 200-kd and 100-kd proteins is associated with an immune-mediated necrotizing myopathy. Arthritis Rheum. 2010;62(9):2757–66. https://doi.org/10.1002/art.27572.
Mammen AL, Chung T, Christopher-Stine L, et al. Autoantibodies against 3-hydroxy-3-methylglutaryl-coenzyme A reductase in patients with statin-associated autoimmune myopathy. Arthritis Rheum. 2011;63(3):713–21. https://doi.org/10.1002/art.30156.
Thompson PD, Panza G, Zaleski A, Taylor B. Statin-associated side effects. J Am Coll Cardiol. 2016;67(20):2395–410. S0735-1097(16)01692-2 [pii].
Phillips PS, Haas RH, Bannykh S, et al. Statin-associated myopathy with normal creatine kinase levels. Ann Intern Med. 2002;137(7):581–5. 200210010-00009 [pii].
Thompson PD, Zmuda JM, Domalik LJ, Zimet RJ, Staggers J, Guyton JR. Lovastatin increases exercise-induced skeletal muscle injury. Metabolism. 1997;46(10):1206–10. S0026-0495(97)90218-3 [pii].
Eijsvogels TM, Januzzi JL, Taylor BA, et al. Impact of statin use on exercise-induced cardiac troponin elevations. Am J Cardiol. 2014;114(4):624–8. https://doi.org/10.1016/j.amjcard.2014.05.047.
Parker BA, Capizzi JA, Grimaldi AS, et al. Effect of statins on skeletal muscle function. Circulation. 2013;127(1):96–103. https://doi.org/10.1161/CIRCULATIONAHA.112.136101.
Ballard KD, Taylor BA, Thompson PD. Statin-associated muscle injury. Eur J Prev Cardiol. 2015;22(9):1161. https://doi.org/10.1177/2047487315586096.
Taylor BA, Lorson L, White CM, Thompson PD. A randomized trial of coenzyme Q10 in patients with confirmed statin myopathy. Atherosclerosis. 2015;238(2):329–35. https://doi.org/10.1016/j.atherosclerosis.2014.12.016.
Taylor BA, Panza G, Thompson PD. Increased creatine kinase with statin treatment may identify statin-associated muscle symptoms. Int J Cardiol. 2016;209:12–3. https://doi.org/10.1016/j.ijcard.2016.02.028.
Rosenson RS, Miller K, Bayliss M, et al. The statin-associated muscle symptom clinical index (SAMS-CI): revision for clinical use, content validation, and inter-rater reliability. Cardiovasc Drugs Ther. 2017;31(2):179–86. https://doi.org/10.1007/s10557-017-6723-4.
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Thompson, P.D. (2020). The Clinical Presentation of Statin-Associated Muscle Symptoms (SAMS). In: Thompson, P., Taylor, B. (eds) Statin-Associated Muscle Symptoms. Contemporary Cardiology. Springer, Cham. https://doi.org/10.1007/978-3-030-33304-1_3
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