twentytwenty domain was triggered too early. This is usually an indicator for some code in the plugin or theme running too early. Translations should be loaded at the init action or later. Please see Debugging in WordPress for more information. (This message was added in version 6.7.0.) in /home4/rahim/public_html/wp-includes/functions.php on line 6131Statin Myopathy \u2013 Part 1<\/p>\n
It\u2019s a common scenario, you walk out of a doctors office with a plan of care that has you all pumped to improve your health \u2013 only to realize you can\u2019t carry it through. As physicians we often frown at these \u201cexcuses\u201d and label patients as noncompliant rather than address the barriers to therapy. If you can\u2019t make it to a physical therapist for your neck strain, we need to work on an alternative plan of care \u2013 not simply expect a single mom to miss work because we said so. There is usually more then one way to skin a cat (no cats were skinned in the writing of this post). Similarly, as a patient, if you feel you are having a side effect of a medication, talk to your doctor \u2013 it may be more common then you think \u2013 and likely have an easy fix. In today\u2019s post I am going to address a common side effect of one of the most commonly prescribed medications known to reduce cardiovascular disease \u2013 Statins.<\/p>\n
Statins<\/a>, as they have come to be known, are the common name to a group of cholesterol reducing medications called HMG Co-A reductase inhibitors. They block one of the essential enzymes in the making of cholesterol and over time have come to be known to have more beneficial effects in reducing artery plaque and cardiovascular disease above and beyond the reduction in bad cholesterol.<\/p>\n Unfortunately many of us who are prescribed statins are intolerant to it. The most common side effect being muscle aches, known as myalgia<\/a> \u2013 and uncommonly actual inflammation of the muscle, known as myositis<\/a>. These are grouped together as myopathy. Myalgia often leaves patients and doctors looking for less beneficial alternatives. I am not going to talk about alternatives in this post, that can of worm is best left to another post.<\/p>\n There are several suspected causes of statin induce myopathy, but there are two that I see most commonly in practice, both fortunately, are easy to rectify. These two have their own clinical sequelae and therefore are equally important to correct, regardless of statin use. These are:<\/p>\n Hypothyroidism is a known cause of statin myopathy, but there is very limited information in the medical literature about low vitamin D. Both are under diagnosed, but easy to treat. I will discuss my thoughts on the former in this post, and the latter in Part 2.<\/p>\n Hypothyroid<\/b><\/p>\n With patients with known hypothyroid state, decisions are easy. As a rule I do not initiate statin therapy, until I have their thyroid function optimized. There are rare exceptions \u2013 I would not withhold statins from someone who is at exceptional risk of a cardiovascular event (such as an impending heart attack).<\/p>\n There are two reasons I would fix their thyroid function before statin therapy.<\/p>\n \u201cMy hypothyroid is subclinical \u2013 so I don\u2019t need meds.\u201d<\/b><\/p>\n Patients are often diagnosed with subclinical hypothyroid when they have\u00a0slightly abnormal function and no symptoms. Sometimes they have\u00a0borderline thyroid function (barely within range) with minimal symptoms, and a decision is made not to treat unless the lab tests look definitely abnormal or if symptoms are at least moderate. I find that many of these patient are susceptible to statin induced myopathy. Not uncommonly, if a previous decision was made to watch thyroid function before considering therapy, statin myopathy would quickly change my mind. If your muscle aches on a statin \u2013 and your thyroid function is less than perfect \u2013 you get a trial of thyroid replacement therapy (TRT). I have found that although I previously thought they may have had subclinical hypothyroidism, these patients often report a signifiant improvement in their sense of well being and quality of life with TRT. This is usually followed by the terrible guilt of not initiating therapy sooner \u2013 their hypothyroidism was probably not as \u201csub\u201d clinical as I had thought.<\/p>\n Coming up next in Part 2 \u2013 Low vitamin D, and its association with statin myopathy, stay tuned.<\/p>\n\n
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