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Statin-Associated Myopathy in a Pediatric Preventive Cardiology Practice
Philip K Johnson1, Michael M Mendelson1, Annette Baker1
1Department of Cardiology, Boston Children's Hospital.
Insights
Pediatric patients on statins showed no increase in creatine kinase (CK) levels, indicating statins are safe for muscle health in children. Routine CK monitoring is unnecessary without symptoms, aligning with current medical guidelines.
Area of Science:
- Pediatric Cardiology
- Pharmacology
- Clinical Practice Guidelines
Background:
- Statin medications are increasingly prescribed to pediatric patients for cardiovascular risk management.
- Concerns exist regarding potential muscle-related adverse effects of statin therapy in children.
- Understanding creatine kinase (CK) levels is crucial for assessing muscle health during statin treatment.
Purpose of the Study:
- To investigate muscle-related adverse effects of statins in a real-world pediatric setting.
- To compare serum CK levels between pediatric patients prescribed and not prescribed statins.
- To evaluate changes in CK levels before and after statin initiation in children.
Main Methods:
- Prospective quality improvement data from a pediatric preventive cardiology practice were analyzed.
- Serum CK levels were compared between statin users and non-users, and pre- vs. post-statin initiation.
- Multivariable mixed-effect models adjusted for patient demographics and clinical factors were employed.
Main Results:
- No significant difference in CK levels was observed between pediatric patients on statins versus those not on statins.
- Statin initiation did not lead to a meaningful increase in CK levels in pediatric patients.
- No muscle symptoms or rhabdomyolysis were reported, even in patients with elevated CK levels.
Conclusions:
- Real-world pediatric data indicate that statin use does not elevate CK levels.
- Routine CK monitoring in asymptomatic pediatric patients on statins has limited utility.
- Findings support current guidelines recommending against routine CK monitoring in the absence of symptoms.
Objectives:
To describe muscle-related statin adverse effects in real-world pediatric practice.
Study Design:
Using prospectively collected quality improvement data from a pediatric preventive cardiology practice, we compared serum creatine kinase (CK) levels among patients prescribed and not prescribed statins, and pre-/poststatin initiation. Multivariable mixed-effect models were constructed accounting for repeated measures, examining the effect of statins on log-transformed CK (lnCK) levels adjusted for age, sex, weight, season, insurance type, and race/ethnicity.
Results:
Among 1501 patients seen over 3.5 years, 474 patients (14?±?4 years, 47% female) had at least 1 serum CK measured. Median (IQR) CK levels of patients prescribed (n?=?188 patients, 768 CK measurements) and not prescribed statins (n?=?351 patients, 682 CK measurements) were 107 (83) IU/L and 113 (81) IU/L, respectively. In multivariable-adjusted models, lnCK levels did not differ based on statin use (??=?0.02 [SE 0.05], P?=?.7). Among patients started on statins (n?=?86, 130 prestatin and 292 poststatin CK measurements), median CK levels did not differ in adjusted models (? for statin use on lnCK?=?.08 [SE .07], P?=?.2). There was a clinically insignificant increase in CK over time (??=?.08 [SE .04], P?=?.04 per year). No muscle symptoms or rhabdomyolysis were reported among patients with high CK levels.
Conclusions:
In a real-world practice, pediatric patients using statins did not experience higher CK levels, nor was there a meaningful CK increase with statin initiation. These data suggest the limited utility to checking CK in the absence of symptoms, supporting current guidelines.