Resolution of Statin-Induced Myalgias by Correcting Vitamin D Deficiency
Correction of hyperlipidemia with statins is often limited by the side-effect of statin-induced myalgias. Vitamin D deficiency is also associated with myalgias that resolve with correction of the vitamin D deficiency. Myalgias associated with statin therapy may also resolve with correction of vitamin D deficiency. This case report presents a case where cardioprotective lipid levels were achieved with a powerful statin only after correction of vitamin D deficiency.
Vitamin D deficiency is endemic in Western society and a strong correlation between low vitamin D levels and myalgias has been reported. Indeed, myalgias resulting from vitamin D deficiency are often misdiagnosed as fibromyalgia. Voluntary muscle has a highly specific nuclear receptor for 1-25 (OH) vitamin D and correction of vitamin D deficiency through its action on this receptor improves muscle strength, physical performance, and myalgias.
Statins are commonly associated with myalgias, less commonly with myositis, and rarely with rhabdomyolysis. The statins that are most commonly associated with myalgias (simvastatin and atorvastatin) inhibit the enzyme CYP3A4. Water soluble statins such as pravastatin, fluvastatin, and rosuvastatin are metabolized by CYP2C9 and are less likely to cause myalgias. The clinical experience of many endocrinologists and cardiologists is that the myalgias associated with statin therapy can often be resolved by correcting vitamin D deficiency. To date there have been reports of correction of muscle weakness and myopathy with resolution of vitamin D deficiency and associations of vitamin D deficiency and myalgias in statin-treated patients who were studied retrospectively. However, to date only one prospective study has reported that the correction of vitamin D deficiency will lead to the resolution of statin-induced myalgias in some patients. In this small case series, four of six patients with statin-induced myalgias and vitamin D deficiency on rechallenge with the same statin following vitamin D repletion and statin therapy was tolerated for at least six months. This report presents a case where, after many years of suboptimal therapy for hyperlipidemia, the identification and correction of vitamin D deficiency resulted in a successful rechallenge with effective statin therapy and for the first time control of hyperlipidemia.
Abstract and Introduction
Abstract
Correction of hyperlipidemia with statins is often limited by the side-effect of statin-induced myalgias. Vitamin D deficiency is also associated with myalgias that resolve with correction of the vitamin D deficiency. Myalgias associated with statin therapy may also resolve with correction of vitamin D deficiency. This case report presents a case where cardioprotective lipid levels were achieved with a powerful statin only after correction of vitamin D deficiency.
Introduction
Vitamin D deficiency is endemic in Western society and a strong correlation between low vitamin D levels and myalgias has been reported. Indeed, myalgias resulting from vitamin D deficiency are often misdiagnosed as fibromyalgia. Voluntary muscle has a highly specific nuclear receptor for 1-25 (OH) vitamin D and correction of vitamin D deficiency through its action on this receptor improves muscle strength, physical performance, and myalgias.
Statins are commonly associated with myalgias, less commonly with myositis, and rarely with rhabdomyolysis. The statins that are most commonly associated with myalgias (simvastatin and atorvastatin) inhibit the enzyme CYP3A4. Water soluble statins such as pravastatin, fluvastatin, and rosuvastatin are metabolized by CYP2C9 and are less likely to cause myalgias. The clinical experience of many endocrinologists and cardiologists is that the myalgias associated with statin therapy can often be resolved by correcting vitamin D deficiency. To date there have been reports of correction of muscle weakness and myopathy with resolution of vitamin D deficiency and associations of vitamin D deficiency and myalgias in statin-treated patients who were studied retrospectively. However, to date only one prospective study has reported that the correction of vitamin D deficiency will lead to the resolution of statin-induced myalgias in some patients. In this small case series, four of six patients with statin-induced myalgias and vitamin D deficiency on rechallenge with the same statin following vitamin D repletion and statin therapy was tolerated for at least six months. This report presents a case where, after many years of suboptimal therapy for hyperlipidemia, the identification and correction of vitamin D deficiency resulted in a successful rechallenge with effective statin therapy and for the first time control of hyperlipidemia.
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