Statin induced myalgia on high intensity statin in patients with Acute Coronary Syndrome

Abstract

Background High intensity statins are recommended in patients with acute coronary syndrome. Statins inhibit atherosclerotic plaque formation in the coronary arteries and reducing the burden of ischemic heart disease, therefore decreasing the morbidity and mortality. Muscle symptoms are most common adverse effect of statins. Hence, the aim of this study is to determine the statin induced myalgia by the statin myalgia clinical score. Purpose To monitor the Statin induced myalgia on high intensity statin in patients with Acute Coronary Syndrome Methods This was an prospective observational study comprised of 418 patients with acute coronary syndrome who were commenced on high intensity statins (Rosuvastatin 20–40mg & Atorvastatin 40–80). These patients were followed at 4 weeks, 8 weeks and 12 weeks subsequently and the clinical myalgia score (SAMS-CI) was calculated at each visit to determine the statin induced myalgia. SAMS-CI was categorized as unlikely (2–6), possible (7–8) and probable (9–11) Results From 418 patients, 327 were males and 91 were females. Mean age was 55.6±11.14. Only 19 (7.63±1.8) patients developed muscle symptoms on high intensity statins (Rosuvastatin 20 mg and Atorvastatin 40 mg) on SAMS-CI Score. 5 patients were unlikely to develop myalgia on SAMS-CI and continued with the same dosage without any new symptoms. 6 patients were possible on SAMS-CI, therefore the dosage of these patients were decreased to moderate intensity statin (Rosuvastatin 10mg, Atorvastatin 20 mg), their symptoms were resolved and continued with the moderate intensity statins. Furthermore, Statin was hold in 8 patients in the probable category for 4 weeks until the resolution of symptoms followed by moderate intensity statins. Conclusion Statin induced myalgia is more reported in old aged and female patients. Most of the patients can better tolerate the lower range of high intensity statins with the similar benefits and should be prescribed in every patient FUNDunding Acknowledgement Type of funding sources: None.

World Heart Federation Cholesterol Roadmap 2022

“…Multiple studies have shown a lack of association between achieved LDL-C levels and adverse events. The commonest adverse effect (myalgia) may be mitigated by cessation of therapy and rechallenge at a similar dose or by a reduction in dose of the statin or reduction in the frequency of dosing (once weekly, twice weekly, alternate doses) or switching to an alternative statin [53][54][55]. Ezetimibe is also now available as a generic therapy in many parts of the world and in many countries as a combination pill with statins.…”