Iran J Basic Med Sci. 2015 Aug;18(8):737-44.
Electrophysiologic and clinico-pathologic characteristics of statin-induced muscle injury.
Iranian journal of basic medical sciences
Mohammed Abdulrazaq, Farqad Hamdan, Waseem Al-Tameemi
Affiliations
Affiliations
- Department of Physiology, College of Medicine, Al-Nahrain University, Baghdad, Iraq.
- Department of Medicine, College of Medicine, Al-Nahrain University, Baghdad, Iraq.
PMID: 26557961
PMCID: PMC4633455
Abstract
OBJECTIVES: In this study, we aimed at evaluation of electrophysiological and histopathalogical characteristics of statin-induced muscle injury as well as clinical features of patients who develop this condition in terms of frequency and pattern of evolution.
MATERIALS AND METHODS: Forty patients (age 39-74 years) including 25 subjects with type 2 diabetes mellitus, 9 with cardiovascular diseases and 6 with hyperlipidemia, who were receiving atrovastatin 40 mg/day for variable period, were studied. Thirty three healthy subjects (age 31-74 years) served as control group. Creatine phosphokinease level, thyroid function, motor unit potential parameters and muscle fiber conduction velocity of biceps brachii and tibialis anterior muscles were measured.
RESULTS: Creatine phosphokinase level was elevated in statin users, particularly in those with diabetes mellitus. Less than 50% of statin users experienced symptoms related to muscle injury. Muscle fiber conduction velocity of the biceps brachii muscle was significantly reduced. Statin users with diabetes mellitus showed significant changes in electrophysiological parameters as compared to those with cardiovascular diseases and hyperlipidemia. Muscle biopsies showed muscle fiber variation in size, fibrosis and mild inflammatory cell infiltration. Immunohistochemical evaluation of muscle biopsies showed positive expression of Bcl-2 and one patient showed positive P53 immunohistochemical expression with elevated level of creatine phosphokinase.
CONCLUSION: Atorvastatin increased average creatine kinase, statins produce mild muscle injury even in asymptomatic subjects. Diabetic statin users were more prone to develop muscle injury than others. Muscle fiber conduction velocity evaluation is recommended as a simple and reliable test to diagnose statin-induced myopathy instead of invasive muscle biopsy.
Keywords: EMG; Histopathology; Immune histochemistry; MFCV; Muscle injury; Statin
References
- Neurology. 1983 Nov;33(11):1453-9 - PubMed
- J Physiol. 1987 Oct;391:561-71 - PubMed
- Clin Pharmacokinet. 2012 Sep 1;51(9):591-606 - PubMed
- Curr Opin Rheumatol. 2010 Nov;22(6):644-50 - PubMed
- Expert Opin Drug Saf. 2011 May;10(3):373-87 - PubMed
- Intern Med J. 2002 Sep-Oct;32(9-10):486-90 - PubMed
- J Neurol Neurosurg Psychiatry. 2009 Aug;80(8):832-8 - PubMed
- Pharmacol Rep. 2011;63(4):859-66 - PubMed
- Cardiovasc Drugs Ther. 2005 Dec;19(6):403-14 - PubMed
- Am J Cardiol. 2006 Apr 17;97(8A):89C-94C - PubMed
- Mayo Clin Proc. 2002 Oct;77(10):1085-92 - PubMed
- Circulation. 2006 Dec 19;114(25):2788-97 - PubMed
- J Pharmacol Exp Ther. 2005 Sep;314(3):1032-41 - PubMed
- J Am Coll Cardiol. 2012 Dec 11;60(23):2384-90 - PubMed
- CMAJ. 2008 Feb 26;178(5):576-84 - PubMed
- Curr Rheumatol Rep. 2010 Jun;12(3):213-20 - PubMed
- Muscle Nerve. 2003 Feb;27(2):142-56 - PubMed
- J Appl Physiol (1985). 2006 Jun;100(6):1837-41 - PubMed
- Circulation. 2013 Jan 1;127(1):96-103 - PubMed
- Curr Neurol Neurosci Rep. 2008 Jan;8(1):66-72 - PubMed
- Am J Cardiol. 2006 Apr 17;97(8A):52C-60C - PubMed
- Curr Opin Rheumatol. 2007 Jan;19(1):67-73 - PubMed
- Arch Phys Med Rehabil. 2005 Mar;86(3 Suppl 1):S18-27 - PubMed
- Ann Pharmacother. 2002 Dec;36(12):1957-60 - PubMed
- Nat Rev Rheumatol. 2012 Aug;8(8):448-57 - PubMed
- Phys Med Rehabil Clin N Am. 2013 Feb;24(1):193-207 - PubMed
- Cancer Res. 2004 Sep 1;64(17):6233-9 - PubMed
- Arch Intern Med. 2005 Dec 12-26;165(22):2671-6 - PubMed
- CMAJ. 2009 Jul 7;181(1-2):E11-8 - PubMed
- J Clin Endocrinol Metab. 2010 Apr;95(4):1663-71 - PubMed
- Carcinogenesis. 2005 May;26(5):883-91 - PubMed
- Am J Cardiol. 2014 May 15;113(10):1765-71 - PubMed
- Neurol Clin. 2000 Aug;18(3):695-718 - PubMed
- J Am Coll Cardiol. 2007 Jun 12;49(23):2231-7 - PubMed
- Ann Intern Med. 2009 Jun 16;150(12):858-68 - PubMed
- J Pharm Pharmacol. 2005 Nov;57(11):1475-84 - PubMed
- Arq Neuropsiquiatr. 2004 Jun;62(2A):257-61 - PubMed
- Neurology. 2008 Oct 7;71(15):e34-7 - PubMed
- Reumatol Clin. 2012 Jul-Aug;8(4):195-200 - PubMed
- J Cardiovasc Pharmacol. 2002 Aug;40(2):163-71 - PubMed
- J Am Med Dir Assoc. 2001 May-Jun;2(3):110-4 - PubMed
- Mayo Clin Proc. 2015 Jan;90(1):24-34 - PubMed
- Muscle Nerve. 2010 Feb;41(2):185-90 - PubMed
- Ann Intern Med. 2002 Oct 1;137(7):581-5 - PubMed
- Drug Saf. 2010 Mar 1;33(3):171-87 - PubMed
Publication Types