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Association of vitamin D and incident statin induced myalgia--a retrospective cohort study

Ghanshyam Palamaner Subash Shantha1, Julio Ramos1, Linda Thomas-Hemak1

  • 1Department of Internal Medicine, The Wright Center for Graduate Medical Education, Scranton, Pennsylvania, United States of America.

Plos One
|March 4, 2014
PubMed

Insights

Low vitamin D levels increase the risk of statin-induced myalgia (SIM). A vitamin D level of 15 ng/ml or lower is highly predictive of developing SIM in patients starting statin therapy.

Area of Science:

  • Endocrinology
  • Pharmacology
  • Primary Care Medicine

Background:

  • Conflicting evidence exists regarding vitamin D's role in statin-induced myalgia (SIM).
  • Previous studies were limited by cross-sectional designs and patient samples from cardiology clinics.

Purpose of the Study:

  • To assess the association between vitamin D levels and SIM in a primary care setting.
  • To establish a serum vitamin D cutoff level for identifying patients at risk of SIM.

Main Methods:

  • Retrospective cohort study of 5526 patients from a primary care practice (2005-2012).
  • Vitamin D (25-hydroxy cholecalciferol) levels at statin initiation were categorized into quartiles.
  • SIM was identified based on patient self-report.

Main Results:

  • Of 1160 patients on statins, 276 (24%) developed SIM.
  • The lowest quartile of vitamin D (≤10 ng/ml) was independently associated with a higher hazard of SIM.
  • A vitamin D cutoff of ≤15 ng/ml demonstrated high predictive accuracy for SIM (LR+ 5.1).

Conclusions:

  • Low vitamin D levels at statin initiation are significantly associated with SIM.
  • A serum vitamin D level ≤15 ng/ml is a strong predictor of SIM.
  • Further randomized controlled trials are warranted to confirm these findings.
Abstract

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