Gillian E Caughey1,2,3, Genevieve M Gabb4,5,6, Saffron Ronson3, Michael Ward3, Timothy Beukelman7, Catherine L Hill5,8,9,10, Vidya Limaye5,10. 1. Discipline of Pharmacology, Adelaide Medical School, University of Adelaide, Adelaide, Australia. 2. Department of Clinical Pharmacology, Royal Adelaide Hospital, Adelaide, Australia. 3. School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia. 4. General Medicine, Royal Adelaide Hospital, Adelaide, Australia. 5. Department of Medicine, University of Adelaide, Adelaide, Australia. 6. Department of Cardiovascular Medicine, Flinders Medical Centre, Bedford Park, Australia. 7. Division of Rheumatology, Department of Pediatrics, University of Alabama at Birmingham. 8. Department of Rheumatology, The Queen Elizabeth Hospital, Woodville, Australia. 9. The Health Observatory, Discipline of Medicines, University of Adelaide, Adelaide, Australia. 10. Rheumatology Unit, Royal Adelaide Hospital, Adelaide, Australia.
Abstract
Importance: Statin medications are widely prescribed for cardiovascular risk reduction. Myalgia and rhabdomyolysis are well-recognized adverse effects of statins, and they resolve with the cessation of statin therapy. Idiopathic inflammatory myositis (IIM) is a heterogeneous group of autoimmune myopathies that may also be associated with statin use. Recently, statin-associated autoimmune myopathy has been recognized as a distinct entity with the presence of specific autoantibodies against hydroxymethylglutaryl-coenzyme A reductase, which results in a necrotizing myositis that does not resolve with cessation of statin therapy and requires treatment with immunosuppressive agents. Objective: To examine the association between histologically confirmed IIM and current exposure to statin medications. Design, Setting, and Participants: Population-based case-control study using the South Australian Myositis Database of all histologically confirmed cases of IIM diagnosed between 1990 and 2014 in patients 40 years or older (n = 221) and population-based controls from the North West Adelaide Health Study (n = 662), matched by age and sex in a 3:1 ratio of controls to cases. Data analysis using conditional logistic regression was performed from June 1, 2016, to July 14, 2017. Exposures: Current statin medication use. Main Outcomes and Measures: Unadjusted and adjusted (for diabetes and cardiovascular disease) odds ratios and 95% CIs for likelihood of inflammatory myositis. Results: A total of 221 IIM cases met the inclusion criteria with a mean (SD) age of 62.2 (10.8) years, and 132 (59.7%) were female. Statin exposure at the time of IIM diagnosis was 68 of 221 patients (30.8%) and 142 of 662 matched controls (21.5%) (P = .005). There was an almost 2-fold increased likelihood of statin exposure in patients with IIM compared with controls (adjusted odds ratio, 1.79; 95% CI, 1.23-2.60; P = .001). Similar results were observed when patients with necrotizing myositis were excluded from the analysis (adjusted odds ratio, 1.92; 95% CI, 1.29-2.86; P = .001). Conclusions and Relevance: In this large population-based study, statin exposure was significantly associated with histologically confirmed IIM. Given the increased use of statins worldwide and the severity of IIM, increased awareness and recognition of this potentially rare adverse effect of statin exposure is needed.
Importance: Statin medications are widely prescribed for cardiovascular risk reduction. Myalgia and rhabdomyolysis are well-recognized adverse effects of statins, and they resolve with the cessation of statin therapy. Idiopathic inflammatory myositis (IIM) is a heterogeneous group of autoimmune myopathies that may also be associated with statin use. Recently, statin-associated autoimmune myopathy has been recognized as a distinct entity with the presence of specific autoantibodies against hydroxymethylglutaryl-coenzyme A reductase, which results in a necrotizing myositis that does not resolve with cessation of statin therapy and requires treatment with immunosuppressive agents. Objective: To examine the association between histologically confirmed IIM and current exposure to statin medications. Design, Setting, and Participants: Population-based case-control study using the South Australian Myositis Database of all histologically confirmed cases of IIM diagnosed between 1990 and 2014 in patients 40 years or older (n = 221) and population-based controls from the North West Adelaide Health Study (n = 662), matched by age and sex in a 3:1 ratio of controls to cases. Data analysis using conditional logistic regression was performed from June 1, 2016, to July 14, 2017. Exposures: Current statin medication use. Main Outcomes and Measures: Unadjusted and adjusted (for diabetes and cardiovascular disease) odds ratios and 95% CIs for likelihood of inflammatory myositis. Results: A total of 221 IIM cases met the inclusion criteria with a mean (SD) age of 62.2 (10.8) years, and 132 (59.7%) were female. Statin exposure at the time of IIM diagnosis was 68 of 221 patients (30.8%) and 142 of 662 matched controls (21.5%) (P = .005). There was an almost 2-fold increased likelihood of statin exposure in patients with IIM compared with controls (adjusted odds ratio, 1.79; 95% CI, 1.23-2.60; P = .001). Similar results were observed when patients with necrotizing myositis were excluded from the analysis (adjusted odds ratio, 1.92; 95% CI, 1.29-2.86; P = .001). Conclusions and Relevance: In this large population-based study, statin exposure was significantly associated with histologically confirmed IIM. Given the increased use of statins worldwide and the severity of IIM, increased awareness and recognition of this potentially rare adverse effect of statin exposure is needed.
Authors: Andrea Mant; Jocelyn Lowinger; Wayne Hall; Susan Whicker; Clare Ringland; Helen Stark Journal: Br J Clin Pharmacol Date: 2006-08-02 Impact factor: 4.335
Authors: Barbara S Wiggins; Joseph J Saseen; Robert L Page; Brent N Reed; Kevin Sneed; John B Kostis; David Lanfear; Salim Virani; Pamela B Morris Journal: Circulation Date: 2016-10-17 Impact factor: 29.690
Authors: L Sailler; C Pereira; A Bagheri; E Uro-Coste; B Roussel; H Roussel; D Adoue; B Fournie; M Laroche; L Zabraniecki; P Cintas; P Arlet; M Lapeyre-Mestre; J L Montastruc; E Arlet-Suau Journal: Ann Rheum Dis Date: 2007-09-03 Impact factor: 19.103
Authors: Pari Basharat; Arash H Lahouti; Julie J Paik; Jemima Albayda; Iago Pinal-Fernandez; Tanmayee Bichile; Thomas E Lloyd; Sonye K Danoff; Livia Casciola-Rosen; Andrew L Mammen; Lisa Christopher-Stine Journal: J Am Coll Cardiol Date: 2016-07-12 Impact factor: 24.094