statins precipitate neuromuscular diseases

[Guest guest]

the neuromuscular diseases in the following case presentations fall

under the heading of " mitochondrial cytopathies " --due to

mitochondrial dysfunction. there are many other neuromuscular

diseases thought to be due to mitochondrial disfunction--

Parkinson's, ALS and Alzheimer's:

 

NEW YORK (Reuters Health) Jul 26 - Patients with asymptomatic

neuromuscular disorders may have their condition precipitated by

statin use, according to investigators from the University of Athens

Medical School.

 

Dr. Panagiota Manta and colleagues describe four such cases in the

July 24th issue of the Archives of Internal Medicine.

 

Case 1 was a 46-year-old man with a history of hypertension and

diabetes mellitus who was prescribed pravastatin for

hypercholesterolemia. Three months later, he complained of fatigue,

muscle pain and stiffness. Serum creatine kinase levels were

persistently elevated. After stopping the drug, creatine kinase

levels fell somewhat and there was mild symptom improvement. Mild

myopathy was seen on needle electromyography and muscle biopsy

showed numerous internal nuclei, nuclear clumps and variations in

fiber size. Genetic testing revealed myotonic dystrophy.

 

Case 2 was a 62-year-old man with a history of MI and diabetes.

Hypercholesterolemia was treated with simvastatin. Creatine kinase

levels became persistently elevated and did not return to normal

after drug discontinuation. Biopsy was positive for muscle enzyme

activity. He was eventually diagnosed with McArdle disease.

 

Case 3 was a 51-year-old man with hypertension and

hypercholesterolemia who was hospitalized with acute rhabdomyolytis

after taking atorvastatin for 18 months. Exercise intolerance and

muscle pain persisted for months after discontinuation of statin

therapy. Some time later, he was diagnosed with mitochondrial

myopathy.

 

The last case was a 58-year-old man with a history of hypertension,

hyperuricemia and coronary artery disease. He began treatment with

pravastatin. Shortly after a dose increase, he developed muscle

twitching, muscle cramps and difficulty walking. Like the other

cases, there was only mild symptom improvement and a modest decline

in creatine kinase levels after the statin was discontinued. He was

eventually diagnosed with Kennedy disease.

 

Statin-induced neuropathy is well recognized and reported more and

more often, Dr. Manta's group notes. These four cases show that

statins can also trigger underlying neuromuscular conditions.

 

The investigators suggest that if neuromuscular symptoms persist

after discontinuation of statin therapy, clinicians should " pursue

further diagnostic evaluations for the detection of underlying

neuromuscular disease. "

 

Arch Intern Med 2006;166:1519-1524.