Assessment and management of statin-associated muscle symptoms (SAMS): A clinical perspective from the National Lipid Association.

Importance
Statin-associated muscle symptoms (SAMS) are common and may lead to discontinuation of indicated statin therapy. Observational studies suggest that vitamin D therapy is associated with reduced statin intolerance, but no randomized studies have been reported.


Objective
To test whether vitamin D supplementation was associated with prevention of SAMS and a reduction of statin discontinuation.


Design, Setting, and Participants
Men 50 years or older and women 55 years or older, free of cancer and cardiovascular disease, were enrolled in a randomized, placebo-controlled, double-blind clinical trial of vitamin D supplementation. Participants who initiated statin therapy after randomization were surveyed in early 2016. The data were analyzed in early 2022.


Interventions
Daily cholecalciferol (2000 international units) or placebo with assessment of statin prescriptions during follow-up.


Main Outcomes and Measures
Muscle pain or discomfort lasting several days (primary outcome) and discontinuation of a statin due to SAMS (secondary outcome).


Results
Statins were initiated by 1033 vitamin D-assigned participants and 1050 placebo-assigned participants; mean (SD) age was 66.8 (6.2) years and 49% were women. Over 4.8 years of follow-up, SAMS were reported by 317 participants (31%) assigned vitamin D and 325 assigned placebo (31%). The adjusted odds ratio (OR) was 0.97 (95% CI, 0.80-1.18; P = .78). Statins were discontinued by 137 participants (13%) assigned to vitamin D and 133 assigned to placebo (13%) with an adjusted OR of 1.04 (95% CI, 0.80-1.35; P = .78). These results were consistent across pretreatment 25-hydroxy vitamin D levels (interaction P value = .83). Among participants with levels less than 20 ng/mL, SAMS were reported by 28 of 85 vitamin D-assigned participants (33%) and 33 of 95 placebo-assigned participants (35%). For those with levels less than 30 ng/ml, SAMS were reported by 88 of 330 vitamin-D assigned participants (27%) and 96 of 323 of placebo-assigned participants (30%).


Conclusions and Relevance
Vitamin D supplementation did not prevent SAMS or reduce statin discontinuation. These results were consistent across pretreatment 25-hydroxy vitamin D levels.


Trial Registration
ClinicalTrials.gov Identifier: NCT01169259.

Statin-Associated Muscle Symptoms Among New Statin Users Randomly Assigned to Vitamin D or Placebo.

Anabolic–androgenic steroids (AAS) are a class of hormones that are widely abused for their muscle-building and strength-increasing properties in high, nontherapeutic, dosages. This review provides an up-to-date and comprehensive overview on how these hormones work and what side effects they might elicit. We discuss how AAS are absorbed into the circulation after intramuscular injection or oral ingestion and how they are subsequently transported to the tissues, where they will move into the extravascular compartment and diffuse into their target cells. Inside these cells, AAS can biotransform into different metabolites or bind to their cognate receptor: the androgen receptor. AAS and their metabolites can cause side effects such as acne vulgaris, hypertension, hepatotoxicity, dyslipidemia, testosterone deficiency, erectile dysfunction, gynecomastia, and cardiomyopathy. Where applicable, we mention treatment options and self-medication practices of AAS users to counteract these side effects. Clinicians may use this review as a guide for understanding how AAS use can impact health and to assist in patient education and, in some cases, the management of side effects.

/pdf/anabolic-androgenic-steroids-how-do-they-work-and-what-are-2wp1jopo.pdf

Anabolic–androgenic steroids: How do they work and what are the risks?

Statin intolerance management: a systematic review

• Manage cardiovascular disease (CVD) risk using an individualised approach, with lifestyle modification as the first step • For people without CVD, assess 10 year risk of a CVD event using QRISK3. This can be done as part of NHS health checks and for people likely to be at high risk based on data available in primary care health records • Tools that estimate the lifetime risk of CVD can be valuable to inform discussions and motivate lifestyle changes, especially in people who have modifiable CVD risk factors but a QRISK3 score less than 10% or age under 40 • Statin therapy is highly cost effective for the primary and secondary prevention of CVD events at all levels of CVD risk, and recommended doses are atorvastatin 20 mg for primary prevention and atorvastatin 80 mg for secondary prevention

Cardiovascular disease risk assessment and reduction: summary of updated NICE guidance

http://www.thelancet.com/article/S0140673622015458/pdf

John Fuller (deceased)

Papers

Effect of statin therapy on muscle symptoms: an individual participant data meta-analysis of large-scale, randomised, double-blind trials