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

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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 (χ2 = 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.

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Study design: patients

The study conformed to the ethical guidelines of the Jewish Hospital Institutional Review Board for human research.

From May 2007 to May 2008, in the temporal order of their referral to our outpatient Cholesterol Center for diagnosis and therapy of hyperlipidemia, serum 25 (OH) vitamin D (D2 + D3) was measured in 687 statin-treated patients, 140 of whom had myositis-myalgia at study entry and 547 patients were asymptomatic. After excluding subjects who were taking corticosteroids or supplemental

Results

We studied 621 statin-treated patients, which consisted of 128 patients with myalgia at study entry and 493 asymptomatic patients. These patients were categorized by low serum 25 OH D (<32 ng/mL), and subsequent treatment with vitamin D supplementation in 38 myalgic, vitamin-D–deficient patients while continuing statin therapy (Fig 1, Fig 2, Tables I–III). All 621 patients had normal thyroid-stimulating hormone and thyroxine.14

The 128 symptomatic and 493 asymptomatic statin-taking patients did

Discussion

The current report revealed that patients with statin-induced myalgias had lower serum vitamin D levels than statin-treated patients without myalgias. Low serum 25 (OH) vitamin D (D2 + D3) is associated with myalgia in statin-treated patients and, while continuing statins, this myalgia can largely be reversed by vitamin D supplementation which normalizes serum vitamin D levels. We speculate that vitamin D deficiency reversibly augments statin-induced myalgias.

In the current study, the

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Supported in part by the Lipoprotein Research Fund and the Medical Research Funds of the Jewish Hospital of Cincinnati.

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