Statin-Associated Myopathy Risk Factors and Management

Patient Risk Factors

The American College of Cardiology identifies advanced age, especially in women over 80 years, as a risk factor for statin-associated myopathy 1, 2, 3
The American College of Cardiology also identifies small body frame and frailty as risk factors for statin-associated myopathy 1, 2, 3
Patients with multisystem disease, especially chronic renal insufficiency due to diabetes, are at increased risk of statin-associated myopathy 1, 2, 3
Perioperative periods and multiple medications also increase the risk of statin-associated myopathy 1, 2, 3

Dehydration can compromise renal function, potentially impairing statin clearance and increasing the risk of myopathy 1, 2, 3
Severe myopathy can progress to rhabdomyolysis with myoglobinuria and acute renal necrosis, and dehydration is a well-known precipitant of acute kidney injury in this setting 1
The American Heart Association notes that exercise-induced muscle injury is exacerbated by statins, and dehydration commonly accompanies strenuous exercise 4, 5

The American College of Cardiology recommends instructing patients on statins to report muscle discomfort, weakness, or brown urine immediately, especially during periods of illness, hot weather, or increased physical activity 4, 5
If muscle symptoms develop in a dehydrated patient on statins, the American College of Cardiology recommends obtaining CK measurement immediately and comparing to baseline, and discontinuing the statin if myositis is present or strongly suspected 4, 5
The American College of Cardiology also recommends addressing hydration status aggressively and monitoring CK and symptoms weekly if CK is 3-10 times upper limit of normal 2, 3