Is Statin Intolerance Real? Thomas Allison, MD: Im Dr Thomas Allison, director of exercise testing and sports cardiology at Mayo Clinic, and I have also worked for many years in the preventive-cardiology clinic. Im joined today by my colleagues Dr Francisco Lopez-Jimenez, who is the director of preventive cardiology at Mayo, and Dr Vinaya Simha, who is an endocrinologist and specialist in lipidology. We are going to talk about statin intolerance. Many patients complain of this. Is this real? And if so, how common is it? Francisco Lopez-Jimenez, MD: It seems to be real. So many patients complain of it every day. Even though the idea has been controversial in the medical community, it is so frequent that there seems to be something going on there. It is reported that approximately 5% of patients taking statins develop some symptoms that can be attributed to the statins.[1] The problem is that we dont really know how common this is, because most clinical trials have run-in periods when they give the medication to patients, and only the patients who come back would be enrolled in the trial. So, unfortunately, we dont have very good evidence. Dr Allison: So they weeded out the patients who didnt tolerate the drug. On the other side of the coin, how many times do you recommend that the patient increase physical activity and start an exercise program at the same time you prescribe a statin? Dr Lopez-Jimenez: Very frequently. So I suspect that the problem is real. It exists. Unfortunately, however, many patients, especially when they have a preconceived notion that statins might be harmful, are more aware of any little aches and pains. On the other hand, we are probably dealing with something real in some patients, and the problem is how to identify them. How Do You Diagnose Statin Intolerance? Dr Allison: Have we yet found a simple test other than talking to the patient? Is there any lab test or anything we can do to distinguish between the patient who is just complaining and somebody who really is reacting to the statin? Vinaya Simha, MBBS, MD: We have traditionally been using creatine kinase (CK) levels, and we have realized that a person can have statin-induced myalgias and even myositis in the absence of biochemical evidence of muscle damage. So the short answer is no. There will be people in whom you cannot biochemically establish that there is statin-induced muscle damage. But in research, we set a very high bar in the sense that unless people have higher than a 10-times elevation in CK levels, we dont label them as having statin-induced myositis. In clinical practice, that is probably a very high bar, and I would never be comfortable waiting for that evidence. If my patient has a three-times to five-times elevation in CK level, that would certainly make me nervous. Dr Lopez-Jimenez: It isa clinical diagnosis. If the symptoms start soon after the patient starts taking the medication, they disappear when the patient stops the medication, and they recur when we try another statin, we can confidently make the diagnosis. medscape/viewarticle/835045…
Posted on: Mon, 01 Dec 2014 00:27:18 +0000
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