A second statin after muscle aches on the first
The evidence
The Cholesterol Treatment Trialists' meta-analysis of 27 trials found that each 1 mmol/l (39 mg/dl) reduction in LDL cholesterol lowered major vascular events by about a fifth. The proportional benefit was at least as large in people whose five-year risk was below 10 %.
The same collaboration pooled 19 double-blind trials for muscle symptoms. Muscle pain or weakness was reported by 27.1 % on a statin and 26.6 % on placebo; more than 90 % of the reports in the statin groups were not caused by the statin.
In SAMSON, 60 people who had stopped a statin for side effects took a statin, a placebo and no tablet in random months. The placebo months produced 90 % of the symptom burden of the statin months, and half of the participants were back on a statin six months later.
What this means for her
- A different statin, at a moderate dose, in the eveningAfter symptoms of this kind the EAS consensus advises a rechallenge rather than permanent avoidance.
- Her CK before the start is in the chart: 96 U/l in MayNew aches can be measured against her own baseline.
- If a second statin also fails, the options without a statin come nextEzetimibe, then bempedoic acid. Both stand in the therapy options with their evidence.
Sources
Written from two meta-analyses, one blinded trial and one consensus statement, read against this chart. Every number links to the publication it comes from.