Statin-Related Muscle Toxicity

yperlipidemia is widely recognized as one of the major risk factors for coronary heart disease (CHD). Whereas therapeutic lifestyle changes are the first-line modality for reducing low-density lipoprotein (LDL) cholesterol, many patients also require medication to achieve cholesterol level goals. Primary and secondary prevention studies have demonstrated that adequate reduction of LDL cholesterol concentrations with lipid-lowering drugs is an effective treatment strategy for reducing coronary morbidity and mortality. Like its predecessors, the third report of the National Cholesterol Education Program Adult Treatment Panel (ATP III) continues to identify elevated LDL cholesterol as the primary target of cholesterol-lowering therapy. This latest report identifies levels of LDL cholesterol below 100 mg/dL as optimal for some groups, increases the thresholds for high-density lipoprotein (HDL) cholesterol from 35 to 40 mg/dL, and decreases the triglyceride (TG) classification thresholds to acknowledge the risks associated with even moderate elevations in TG. Furthermore, the new guidelines incorporate a modified Framingham Risk Prediction Score for estimating 10-year CHD risk, which recommends that patients with a 10-year risk for CHD greater than 20% should be treated in the same way as patients with established CHD. Based upon ATP III’s lower cutpoints for treatment, it is estimated that more than 102 million Americans have undesirable total cholesterol levels (values greater than 200 mg/dL), of whom 41.3 million exhibit profound elevations (greater than 240 mg/dL). These new data represent a substantial increase in the total number of Americans who can benefit from statin therapy. In addition to the numerous reports of the efficacy of statins in preventing CHD and cerebrovascular disease and slowing their progression, recent studies point to additional indications for statin therapy. Such indications may include reducing proteinuria and slowing the progression of renal insufficiency in those with kidney disease and reducing Statin-Related Muscle Toxicity