Statin Myopathy – Part 2
For those of you who survived part 1, where we discussed hypothyroidism and its association with statin myopathy, here is part 2.
Vitamin D deficiency
Like my patients with known hypothyroidism, unless at excessive cardiovascular risk I always treat known vitamin D deficiency prior to instituting statin therapy.
Unlike hypothyroidism, vitamin D deficiency can be completely silent, found only by either routine screening, or if suspected such as with statin induced myalgia or another reason such as osteoporosis – a little late I suspect. At risk are those who do not get adequate exposure to daylight, darker skin individuals, and those with inadequate animal food intake (meat, fish, eggs). One of my colleagues, a nephrologist, was skeptical. He is of Indian (South Asian – not Native American) and complained of muscle aches (myalgia) with a statin. As suspected, his vitamin D level was abysmal, and after 3 months of replacement therapy, he could take his statin without any problems. Similarly, I have found innumerable “statin intolerant” patients like him to suffer from underlying vitamin D deficiency and after replacement therapy, were able to tolerate their statin without any myalgia. As a result, I have made it part of my practice to routinely screen my patients for Vitamin D deficiency every few years along with one of their annual physicals or sooner if there are any complaints of myalgia especially if associated with statin use.
“Queen, you are full fair, ’tis true, but Snow White is fairer than you.”
If your name is not Snow White, you are probably at risk of vitamin D deficiency – but your skin cancer risk is probably a fraction of hers. It seems that although skin pigment may protect from skin cancer to a degree, it unfortunately also “protects” us from vitamin D. The most widely known performer in the history of reggae, Bob Marley, was Jamaican and died from melanoma – so please don’t assume that if you are not fair, you can’t get skin cancer. The World Health Organization has identified ultraviolet light a human carcinogen – known to cause cancer in humans. There is clear reason why sunlight has never been recommended for vitamin D deficiency – it causes cancer, and vitamin D is just as easily replaced by oral supplements – so please be careful.
To conclude, I don’t view statin myopathy as a bad thing. It begs investigation for an underlying disorder which if left unchecked may be harmful in its own right, regardless of statin use. I view it as a tip – something is wrong and I haven’t looked yet. Both hypothyroidism and hypovitaminosis D effect people every day – spend a single day in any primary care office, and you will be stunned as to how much.
I hope you found this blog post helpful. I know the two part post must have been an excessively lengthy read and appreciate your time.
If you or anyone you know has had similar experience with muscle aches from cholesterol medications, which improved after an underlying cause was addressed, please share in the comments below. Patients are my greatest source of knowledge, and I am always looking to tap into their experiences to advance my knowledge of medicine.
As always, any constructive critique is always welcome as well.