Primary Evaluation and Management of Statin Therapy Complications

Dean A. Seehusen, MD, MPH, FAAFP; Chad A. Asplund, MD; Dawn R. Johnson, DO; Kevin Horde, A. DO

Disclosures

South Med J. 2006;99(3):250-254. 

In This Article

Monitoring CK Levels

Despite a lack of evidence for utility,[15,16] many physicians choose to periodically monitor CK levels. Smith et al[17] evaluated the practice at the primary care center of Beth Israel Deaconess Medical Center during 1998 and found that over half of the patients receiving statin therapy had their CK levels monitored. Less than 1% of these patients were found to have significantly elevated CK levels and in none of the patients was it felt to be attributable to statin therapy. CK levels rise suddenly in severe myopathy, not gradually, so screening is unlikely to be beneficial.[1] The ACC, AHA and NHLBI,[5] in their combined clinical advisory on the use and safety of statins, do not endorse routine monitoring of CK levels in patients taking statin medications. Sniderman6[1] has also argued saliently that such monitoring is potentially harmful by leading physicians to discontinue statins in patients at high risk for cardiovascular events.

It has also been shown that some patients can have normal CK levels and still have histologic evidence of myopathy. Phillips et al8[1] reported a study of four patients without CK elevations who had pathologic changes consistent with myopathy on muscle biopsy. These patients had muscle complaints while taking statins which resolved when switched to placebo in a blinded manner and recurred with reinstitution of therapy. The histologic changes resembled abnormalities previously reported in metabolic abnormalities and coenzyme Q10 deficiency.

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