Statin use in transthyretin amyloid cardiomyopathy: Assessing tolerability and drug interaction risks with tafamidis

Transthyretin cardiac amyloidosis (ATTR-CM) is a progressive cardiomyopathy treated with tafamidis, a transthyretin stabilizer that improves survival and quality of life. Tafamidis inhibits the breast cancer resistance protein (BCRP), raising concern for drug-drug interactions, particularly with rosuvastatin.

To evaluate the potential interaction between tafamidis and statins in patients with ATTR-CM.

We conducted a retrospective study of 103 patients with confirmed ATTR-CM receiving both tafamidis and statin therapy at Columbia University Irving Medical Center.

The most commonly prescribed statins were atorvastatin (61%) and rosuvastatin (30%). Fourteen patients (12%) experienced changes in their statin regimen, with 7 involving rosuvastatin and 6 with atorvastatin due to adverse effects or proactive adjustments. Myalgias and elevated liver enzymes were the most frequent adverse events. One case of rhabdomyolysis was reported with atorvastatin 80 mg. Risk factors for statin intolerance, including advanced age and use of amiodarone, contributed to statin change.

Our findings highlight the need for individualized statin selection in ATTR-CM patients treated with tafamidis, favoring statins with lower dependency on BCRP and efflux transporters with cautious dosing. Patients should be monitored for muscle-related symptoms and alternative lipid-lowering agents should be considered when appropriate to optimize safety and treatment efficacy.