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Statin-induced myopathy

Guidelines

Key sources

The following summarized guidelines for the evaluation and management of statin-induced myopathy are prepared by our editorial team based on guidelines from the Baveno VII Consensus Workshop (Baveno VII 2022), the American College of Preventive Medicine (ACPM/ADA/PCNA/ABC/ASPC/AAPA/AGS/AHA/ACC/APhA 2019), the Canadian Cardiovascular Society (CCS 2016), and the American Heart Association (AHA/ACC 2014). ...
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Screening and diagnosis

Screening for adverse effects: as per AAPA/ABC/ACC/ACPM/ADA/AGS/AHA/APhA/ASPC/PCNA 2019 guidelines, assess appropriate safety indicators 4-12 weeks after statin initiation or dose adjustment and every 3-12 months thereafter based on the need to assess safety.
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Diagnostic investigations

Clinical assessment: as per AAPA/ABC/ACC/ACPM/ADA/AGS/AHA/APhA/ASPC/PCNA 2019 guidelines, obtain a thorough assessment of symptoms in patients with statin-associated muscle symptoms, in addition to an evaluation for non-statin causes and predisposing factors.
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  • Laboratory tests

Medical management

Treatment modifications: as per AAPA/ABC/ACC/ACPM/ADA/AGS/AHA/APhA/ASPC/PCNA 2019 guidelines, switch to moderate-intensity statin therapy with the aim of achieving a 30-49% reduction in LDL-C levels in patients with clinical ASCVD experiencing statin-associated side effects on high-intensity statin therapy.
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Specific circumstances

Patients with chronic liver disease
As per Baveno VII 2022 guidelines:
Prescribe statins at a lower dose (such as simvastatin at a maximum of 20 mg/day) in patients with Child-Pugh B and C cirrhosis, and obtain close monitoring for muscle and liver toxicity.
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Restrict the use of statins in patients with Child-Pugh C cirrhosis since their benefit in these patients has not been proven yet.
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Preventative measures

Pretreatment assessment
As per AAPA/ABC/ACC/ACPM/ADA/AGS/AHA/APhA/ASPC/PCNA 2019 guidelines:
Conduct a clinician-patient risk discussion before initiating statin therapy to review net clinical benefit, weighing the potential for ASCVD risk reduction against the potential for statin-associated side effects, drug-drug interactions, and safety while emphasizing that side effects can be addressed successfully,
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as well as to promote shared decision-making taking into account patient preferences.
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Identify potential predisposing factors for statin-associated side effects, including new-onset diabetes mellitus and statin-associated muscle symptoms, before initiating statin therapy.
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