Role of Vitamin D Deficiency in Statin Induced Myalgia

 
Statin drugs are the most commonly used medications for reducing cholesterol levels. They help prevent cardiovascular disease through their cholesterol reducing effects. Statins are not free from side effects. They are well known to have the ability to induce muscle pain (myalgia).

There has been a recent study which looked at the relationship between vitamin D levels and myalgia in more than 600 individuals taking statins. Some of the study subjects had myalgia, while some did not. In those with myalgia, blood vitamin D levels were generally lower (28.6 v 34.2 ng/mL). Also low blood levels of vitamin D were found in 64 per cent of patients with myalgia, compared to 43 per cent of symptom-free individuals.

After this, some of the myalgic patients with vitamin D deficiency were treated with vitamin D at a dose of 50,000 IU each week for 12 weeks. Vitamin D levels rose from an average of about 20 ng/ml to an average of 48 ng/ml.

But perhaps most importantly of all, this led to a resolution of myalgia in more than 92 per cent of the individuals treated.

This research suggested that vitamin D deficiency may be an underlying factor in myalgia in statin-treated individuals.

Study

Low serum 25 (OH) vitamin D levels (<32 ng/mL) are associated with reversible myositis-myalgia in statin-treated patients ¹.

Our specific aims were to determine whether low serum 25 (OH) vitamin D (D2 + D3) (<32 ng/mL) was associated with myalgia in statin-treated patients and whether the myalgia could be reversed by vitamin D supplementation while continuing statins. After excluding subjects who took corticosteroids or supplemental vitamin D, serum 25 (OH) D was measured in 621 statin-treated patients, which consisted of 128 patients with myalgia at entry and 493 asymptomatic patients. The 128 myalgic patients had lower mean +/- standard deviation (SD) serum vitamin D than the 493 asymptomatic patients (28.6 +/- 13.2 vs 34.2 +/- 13.8 ng/mL, P < 0.0001), but they did not differ (p > 0.05) by age, body mass index (BMI), type 2 diabetes, or creatine kinase levels. By analysis of variance, which was adjusted for race, sex, and age, the least square mean (+/- standard error [SE]) serum vitamin D was lower in the 128 patients with myalgia than in the 493 asymptomatic patients (28.7 +/- 1.2 vs 34.3 +/- 0.6 ng/mL, P < 0.0001). Serum 25 (OH) D was low in 82 of 128 (64%) patients with myalgia versus 214 of 493 (43%) asymptomatic patients (chi(2) = 17.4, P < 0.0001). Of the 82 vitamin-D-deficient, myalgic patients, while continuing statins, 38 were given vitamin D (50,000 units/week for 12 weeks), with a resultant increase in serum vitamin D from 20.4 +/- 7.3 to 48.2 +/- 17.9 ng/mL (P < 0.0001) and resolution of myalgia in 35 (92%). We speculate that symptomatic myalgia in statin-treated patients with concurrent vitamin D deficiency may reflect a reversible interaction between vitamin D deficiency and statins on skeletal muscle.

Reference
1. Ahmed W, Khan N, Glueck CJ, Pandey S, Wang P, Goldenberg N, Uppal M, Khanal S. Low serum 25 (OH) vitamin D levels (<32 ng/mL) are associated with reversible myositis-myalgia in statin-treated patients. Transl Res. 2009 Jan;153(1):11-6. Epub 2008 Dec 6