Statin Induced Myopathy

In 28 years of clinical experience,Ray ban Wayfarer, I have seen one case of significant myopathy resulting in hospitilization but with a good outcome relatable to the use of statin (in this case the inappropriate concuurent use with cyclosporin).

Perhaps a niche for this test would be in relatives of patients who exeperienced myopathy with statins,carrera pas cher.

I concur with the below comment regarding the low risk of biochemically evident myopathy,ray ban pas cher. I personally avoid simvastatin 80 due to a higher risk suggested in the A to Z trial. I would like a reference regarding the HPS and the gene-myopathy connection,ray ban pas cher. I do think validation in the case of other statins would be helpful,abercrombie soldes. I am skeptical regarding routine use of this test unless its discriminatory value for myopathy (ROC curves) is demonstrated for simva 40,ray ban, atorva 40,oakley, and/or rova20/40 is established.

On a related issue,oakley pas cher, I am interested in your opinion regarding the already marketed KIF6 genotyping.

I also concur with the last 2 comments on the extremely low risk of myopathy with statins,oakley radar. Translational medicine has not really made an impact on clinical lipidology to this point. Although a fascinating field to academics, such as Dr Topol, it just is not making much impact on the day to day practice of clinical medicine. I treat 400-600 patients for lipids monthly and I have maybe 1-2 patients/year who cannot tolerate statins due to myopathy. It just isn’t the big problem its made out to be by talking heads who don’t see patients on a daily basis.

Some important comments here. ApoA1 must have some unusual patients since mucle aches/pain is the most common side effect of statins, and in fact set up the ezetimibe market,lunette oakley. I have treated patients with statins for over 20 years and the incidence of this side ffect becoming an issue for patients is at least 5-10%,lunettes ray ban, many stimate much higher. This is not an academic issue,lunette oakley. Ceruvastatin (Baychol) was taken off the market since it induced rhabdomyolysis and deaths—likely indexed to the same gene. The story is not just about marked CK rise 10 fold or greater,lunette carrera. There are series of patients who have muscle biopsy proven myositis without CK blood level excess,oakley pas cher.

Agree with D. Powell that we need more data on all statins. I think the KIF6 story in intriguing but we need more info on that marker as well. The reference in NEJM July 31 has all the related HPS info.

The amioadorone-statin interaction is yet another example of the problem, with many clinicians not aware of the need to go to lower statin doses when using amiodarone concurrently,oakley. Learning the pathway for this myopathy unintended yet frequent effect sets up the potential to prevent it in the future.

My patient population is probably not as wealthy as yours since you practice in beautiful La Jolla and I practice in the inner city of Atlanta,lunette carrera pas cher. But the 5-10% that complain of muscle pain like my toe hurts or my knee aches with normal CPK and no improvement with withdrawal of statins, I do not consider clinically significant,ray ban. And I don’t nor do I know of any guidelines that require one to preform a muscle biopsy to rule out myositis in patients who have muscle pain with a statin,oakleyradar. If you just switch many of these patients to a differant statin or actually look at their med list to see if the statin metabolism was interfered with like the amiodarone example you have your answer,abercrombie femme. Also many of the market leaders metabolism is through P450 3A4 (atorvastatin) which results in alot of drug/drug interaction. In fact the majority of Rhabdo cases with cerivastatin was because it was combined with lopid,oakley pas cher. The only statin that doesn’t interact with lopid is fluvastatin,Abercrombie & Fitch. In fact in a recent study patients deemed intolerant to statin were placed on Lescol up to 80mg without a problem in a majority of these patients,lunette carrera. In that very very small group of patients that truely have clinically significant myopathy(symmetric large muscle pain with profound weakness with or without CPK elevation) I will consider KIF6,abercrombie store. But again this is 1-2 patients/year,discount ray ban. Now if guidelines change and I must do muscle biopsy to rule out myositis this may change. But I doubt I will live long enough to see this happen,lunettes ray ban.

In many cases alternative modes of lipid lowering therapy are available to address both the advantages of statins and the potential,lunette carrera pas cher, low risk, disadvantages of statins. These include bile acid sequestrants,ray ban pas cher, particularily, colsevelam,ray ban, which is a more tolerable bas,boutique lunette carrera, niacin, and a multitude of supplements which have shown to reduce levels of low density lipoproteins,lunette carrera pas cher.

These other medicines can be employed alone, or in combination with the statin,carrera pas cher. If the higher doses of statins are your concern add a non-systemic agent such as colsevelam to your existing low dose statin regimen,lunette carrera pas cher.

I’m not a doctor but a user of statins,oakley. All of my family memebers take them in one form or another because we have very high cholesterol levels in our family. My doctor told me about the KIF6 test today and I am going to have it done,abercrombie femme. All of my family members deal with muscle pain from the statins. We just don’t make a big deal about it to our doctors because we’ve all been told that we absolutely have to be on the statins or risk serious heart disease. You learn to put up with the muscle pain and digestive side affects (zetia). So maybe some doctors don’t hear a lot of complaints about muscle pain,Abercrombie, but it’s there. I’m hoping this test will help my doctor decide if I really need to be on statins and how much and what kind. I am 66 and have a lot of living yet to do,lunettes ray ban moisn cher! But the muscle pain I experience is almost overwhelming,carrera pas cher. Any help I can get will improve my daily life so that I can enjoy my golden years,lunette carrera! Thanks for listening.

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