#334 Wouldn’t Bet On it: What is the risk of muscle symptoms on statins?

Reading Tools for Practice Article can earn you MainPro+ Credits
Join NowAlready a CFPCLearn Member? Log in
- 7 systematic reviews [11-135 randomized controlled trials (RCTs); 18,192-192,977 patients] from the last 5 years.1-7 Focusing on the most recent (23 RCTs; 154,664 patients x4.3 years).1 Results statistically significant unless indicated.
- Any muscle symptoms, statin versus placebo,
- Anytime: 27.1% versus 26.6% (placebo).1
- Within 1st year: 14.0% versus 14.8%, number needed to harm=125.
- After 1st year: 14.8% versus 15.0% (not statistically different).
- Other systematic reviews2-7 similar but not statistically different for myalgia,5 ≥65 age subgroup,4 or intensity subgroups versus placebo.2
- No difference by statin type,3 lipophilic/hydrophilic statin,6 or age groups.1,5,6
- Anytime: 27.1% versus 26.6% (placebo).1
- Any muscle symptoms, more versus less-intense statin:
- Any timepoint: 36.1% versus 34.8% (less intense).1
- Other systematic reviews found similar.2
- Creatine kinase >10x upper limit of normal (myopathy): 077% versus 0.044% (placebo).1
- 4 other systematic reviews:2-5 No difference.
- More versus less-intense statin:1,2 Results no different for approved statins/doses (excluding simvastatin 80mg).
- Rhabdomyolysis:
- 3 systematic reviews: 4,5 No difference.
- Discontinuation for muscle symptoms2,4 or any adverse event4,5,7 not statistically increased.
- Any muscle symptoms, statin versus placebo,
- Three n-of-1 trials (8-200 patients, previous statin intolerance due to muscle symptoms) randomized to 3-4 cycles of ~3-8 weeks of statin,8-10 placebo,8-10 and no-pill8 Muscle symptom scores:
- Statin versus placebo:8-10 no difference.
- Statin versus no-pill:8 16 versus 8 (no-pill) (scale=0-100, higher worse).
- Mean creatine kinase rise1 with statin therapy ~2%.
- Events like myopathy and rhabdomyolysis are too infrequent to discern statin effects in meta-analysis of >100,000 RCT participants.
- Statin-induced rhabdomyolysis estimated at 2-3 excess cases/100,000 patient-years.11
- Guidelines recommend:
- In patients with non-severe muscle-symptoms, offer retrial of same or lower-intensity statin.12
- Monitoring creatinine kinase is generally not encouraged, but check if symptoms or high-risk.12,13