55M IHD with prior stents; prior myalgia with Simvastatin and Atorvastatin; but yet still more myalgia with Pravastatin. The treating physician decided to check his vitamin D level and his coenzyme Q10 level.
Which one, vitamin D level or coenzyme Q10 level, is relevant in statin myalgia?
A recent study on vitamin D and statins is intriguing. A meta-analysis of seven observational studies with 2400 patients showed that patients with statin associated myalgia has significantly lower plasma vitamin D levels and those without muscle ache. (1)
A small study further demonstrated that in statin intolerant patients who had a low vitamin D level of <32ng/mL, weekly 50,000 to 100,000 units of vitamin D supplementation resulted in an improvement in statin tolerance. In fact, at 24 months, 95% of those who had normalised vitamin D levels remain on the statin. (2)
Certainly, this will need further study due to the small number of patients in these trials. However, it may be another useful strategy to try.
On the other hand, coenzyme Q10 does not appear to be effective in the treatment of statin related myalgia, according to a recent meta analysis of randomised controlled trials demonstrating the lack of effectiveness of coenzyme Q10 supplementation on either muscle pain or plasma creatine kinase (CK) level. (3)
Michalska-Kasiczak M, Sahebkar A, Mikhailidis DP, et al; Lipid and Blood Pressure Meta-analysis Collaboration (LBPMC) Group. Analysis of vitamin D levels in patients with and without statin-associated myalgia—a systematic review and meta-analysis of 7 studies with 2420 patients. Int J Cardiol. 2015;178:111-116.
Khayznikov M, Hemachrandra K, Pandit R, Kumar A, Wang P, Glueck CJ. Statin intolerance because of myalgia, myositis, myopathy, or myonecrosis can in most cases be safely resolved by vitamin D supplementation. N Am J Med Sci. 2015;7:86-93.
Banach M, Serban C, Sahebkar A, et al; Lipid and Blood Pressure Meta-analysis Collaboration Group. Effects of coenzyme Q10 on statin-induced myopathy: a meta-analysis of randomized controlled trials. Mayo Clin Proc. 2015;90:24-34
Dr Andrew To