statininduced

Statin-induced refers to adverse effects attributed to statin medications, which are widely used to lower cholesterol and reduce cardiovascular risk. The most commonly reported problem is statin-associated muscle symptoms (SAMS), but liver enzyme elevations, diabetes risk, cognitive complaints, and rarely serious muscle breakdown can occur.

The mechanisms underlying statin-induced effects are not fully understood. Muscle symptoms may relate to genetic factors, mitochondrial effects, or interactions that increase statin exposure in muscle tissue. A well-described genetic variant in SLCO1B1 can raise the risk of simvastatin-associated myopathy. Lipophilicity of a statin and drug interactions with other medications can also influence risk.

Common adverse effects include myalgia (muscle pain without weakness), myopathy (muscle weakness with or without elevated CK), and, rarely, rhabdomyolysis. Liver enzyme elevations occur in a small percentage of patients, usually transient and asymptomatic. Some studies have noted a small increase in the risk of new-onset diabetes with statin use, particularly with higher-intensity therapy. Cognitive complaints have been reported anecdotally, but robust evidence does not show that statins cause meaningful cognitive decline in most people.

Risk factors for statin-induced effects include older age, female sex, reduced kidney function, hypothyroidism, high-dose or high-potency statins, and drug interactions with agents that increase statin levels. Baseline and symptom-driven monitoring is guided by clinical status rather than routine CK testing in asymptomatic patients.

Management typically involves reassessing the statin therapy, withholding the drug if severe symptoms occur, and then re-challenging with a different statin or lower dose if appropriate. When statins are not tolerated, non-statin lipid-lowering therapies such as ezetimibe, PCSK9 inhibitors, bempedoic acid, or inclisiran may be considered.