Who needs to be monitored for statin induced adverse events
Which patients should be monitored for statin induced adverse events?
Myopathy is the most common adverse event due to statin therapy and can occur in up to 10% of persons taking the drug.
Of the statins, pravastatin, fluvastatin, and rosuvastatin are ones associated with the lowest risk of myopathy, especially when concomitant drugs that inhibit cytochrome P450 3A4 cannot be avoided.
In addition, fibrates have a synergistic effect on the occurrence of myopathy in patients already receiving statins, and this may be partially responsible for their limited use to treat hypertriglyceridemia in patients with advanced CKD.
Certain patient populations, such as the elderly, (>80 years), frail persons, Asian populations, and those with underlying liver disease, may be at an increased risk of adverse events from statin therapy. Routine monitoring is not recommended.
Decreasing the dose of the drug, switching to a statin with less myopathy risk, and vitamin-D repletion if deficient are some strategies that can be adopted to mitigate the risk of myopathy.
Persons who develop statin-induced rhabdomyolysis should not be treated with statins in the future due to the risk of recurrence. Alternatives, such as PCSK9 inhibitors, may be considered.
