Investigation of muscle symptoms associated with statin therapy

In a recent study published in lancet Journal, investigators investigated the impact of statin treatment on muscle symptoms.

Background

Atherosclerotic cardiovascular disease, such as ischemic stroke and myocardial infarction, will kill approximately 18 million people worldwide in 2019, and low-density lipoprotein (LDL) cholesterol is a significant risk factor. 3-hydroxy-3-methylglutaryl-coenzyme A reductase (HMG-CoA) inhibitors, or statins, can lower LDL cholesterol levels in the long term. , the risk of myocardial infarction and ischemic stroke is reduced by about 25%. As a result, statins are administered today by millions of people around the world.

Although statin therapy is widely prescribed and has been successful in preventing atherosclerotic cardiovascular disease, concerns persist that it may frequently cause muscle weakness and pain. A reliable assessment of how regimens affect muscle symptoms under different clinical scenarios is needed.

About research

In the current study, researchers found that statins reduced muscle weakness using a meta-analysis of individual subject information for all adverse muscle symptoms in a long-term, large-scale, randomized, double-blind study of statin therapy. The current meta-analysis explored differences in statin regimens and the effect of statin medication on muscle effects of varying severity among different types of people, with additional findings. We sought to examine how risk changes over time.

The study included a randomized trial of statin therapy with a minimum enrollment goal of 1000 volunteers and a planned treatment duration of at least 2 years. In addition, eligible studies must compare statins with placebo or compare more stringent statin regimens with less stringent regimens in a double-blind fashion.

The team included 123,940 individual subject data from 19 double-blind studies comparing statin therapy with placebo treatment and 30,724 individual subject data from 4 double-blind studies comparing more intensive statin therapy with less rigorous regimens. individual subject data were examined. In addition, a conventional inverse variance-weighted meta-analysis of the effect of muscle on outcome was performed according to the prescribed protocol.

result

Findings: Of 19 placebo-controlled studies involving subjects with a mean age of 63 years, 27.9% (34,533) were female, 48.1% (59,610) were volunteers with a history of vascular disease, volunteer. Additionally, of these participants, 27.1% (16,835) in the statin group and 26.6% (16,446) in the placebo group reported muscle weakness or pain at a weighted mean follow-up of 4.3 years.

The authors found a 7% relative increase in muscle soreness or weakness during the first year of statin therapy. These values ​​translate into 11 absolute surplus rates ranging from 6 to 16 incidence rates per 1000 person-years. This reasoning indicates that only one-fifteenth of these muscle-related reports by subjects assigned to statin therapy were actually induced by statins. Of note, there was no significant increase in initial reports of muscle weakness or pain after 1 year.

High-intensity statin regimens conferred a higher relative risk (RR) than moderate- or low-intensity regimens compared to placebo. More intensive statin therapy included atorvastatin 40-80 mg or rosuvastatin 20-40 mg once daily. Moreover, after the first his year, a small RR excess was observed with the more intensive regimen.

There was no conclusive evidence that RR differs between different statins or under different clinical conditions. Moreover, median creatine kinase levels increased negligibly after statin dosing (approximately 0.02 times the upper limit of normal).

Conclusion

Study results showed that statin therapy resulted in a slight excess of mainly mild muscle soreness. I have not. The authors noted that the proven cardiovascular benefits far outweigh the small risk of muscle dissatisfaction from statins. I mentioned the need to

The team minimized bias by restricting evaluation to statin therapy compared to placebo in a large, randomized, double-blind study using unbiased systematic event reporting. rice field. They collected information on all muscle-related adverse events recorded in each study subject. We coded them using different pathological criteria.

In addition, researchers say that access to individual subject data has made it possible to assess the risk of statins more individually than before. These assessments included those examining the timing of additional risk, distribution of treatment impact, and impact on specific symptoms in different patient types.