Neuromuscular Complications of Statin Therapy
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(2020) 20:47
NEUROLOGY OF SYSTEMIC DISEASES (J. BILLER, SECTION EDITOR)
Neuromuscular Complications of Statin Therapy Elena Crisan 1,2
&
Vijaya K. Patil 1,2
# This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply 2020
Abstract Purpose of Review This review provides an overview of neuromuscular side effects associated with statin use, their diagnosis, and treatment. Recent Findings The discovery of anti-HMGCR antibodies led to a better understanding of clinical aspects of statin-associated anti-HMGCR myopathy and its treatment. Summary Statins are widely prescribed medications with well-established benefits in the treatment of cardiovascular diseases and stroke. Adherence to statins is influenced by development of side effects, especially muscle related. There is wide range of neuromuscular side effects associated with statin therapy. Documented neuromuscular side effects include asymptomatic elevation of muscle enzymes, mild-moderate myalgias and cramps, toxic and immune-mediated severe necrotizing myopathy, and rare cases of rhabdomyolysis. In addition, statins can lead to unmasking or triggering of underlying muscle and neuromuscular junction disorders. This article identifies the risk factors and provides a review of neuromuscular side effects associated with statin use, their diagnosis and treatment. Keywords Muscle adverse events . Anti-HMGCR myopathy . Anti-HMGCR antibodies . Myasthenia gravis . Neuropathy . Immunosuppression therapy
Introduction Statins are generally safe, well-tolerated and effective medications. They are widely used in the primary and secondary prevention of cardiovascular disease and stroke. They inhibit the function of 3-hydroxy-3-methylglutaryl coenzyme A reductase (HMGCR) in cholesterol biosynthesis leading to reduction in serum cholesterol. Many patients taking statins report muscle-related symptoms that prevent the use of the guideline recommended doses. Previous literature reports showed that muscle-related events were the most common reason for discontinuation of statin therapy [1]. It is important to emphasize the statin-related neuromuscular side effects This article is part of the Topical Collection on Neurology of Systemic Diseases * Elena Crisan [email protected] 1
Department of Neurology, Edward Hines Jr VA Medical Center, 5000 S 5th Ave, Hines, IL 60141, USA
2
Department of Neurology, Loyola University Medical Center, 2160 S. First Ave, Maywood, IL 60153, USA
because statin-intolerance has a major impact on the care of cardiovascular patients. Statin intolerance is associated with 50% increased recurrent myocardial infarction as well as an equal risk of hospitalization for recurrent cardiovascular events [1, 2].
Statin-Associated Muscle Adverse Events Statin-associated muscle adverse events occur with all statins. In clinical practice, statin therapy has been associated with muscle problems, especially myalgia and cramps, in approximately 10–29% of treated patients [1, 3]. However, a systematic revi
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