Statin-associated Muscle Symptoms — EECC MCQ

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ModerateCardiac PharmacologyStatin-associated Muscle SymptomsEECC

A 52-year-old woman started on atorvastatin 40 mg 6 weeks ago develops myalgia with a creatine kinase (CK) level of 1,800 U/L (normal <170 U/L). She has no rhabdomyolysis features (normal renal function, no myoglobinuria). What is the most appropriate management?

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Correct answer: B — Stop atorvastatin, recheck CK in 6 weeks, and if normalised, rechallenge with a different statin at a lower dose

Statin-associated muscle symptoms (SAMS) with CK elevation >4x ULN but <10x ULN warrant statin discontinuation and re-evaluation. The ESC/EAS Dyslipidaemia Guidelines recommend: (1) Stop the statin and allow symptoms and CK to resolve (typically 6 weeks); (2) Rechallenge with a different statin (hydrophilic statins like rosuvastatin or pravastatin may be better tolerated) at a low dose, with gradual up-titration; (3) If intolerant to multiple statins, consider alternate-day dosing of a long-acting statin (rosuvastatin) or non-statin alternatives (ezetimibe, bempedoic acid). CK >10x ULN suggests rhabdomyolysis and requires urgent renal assessment. Permanent statin avoidance is inappropriate without attempting rechallenge, given the strong mortality benefit.

Reference: ESC/EAS (2019/2025): Guidelines for the Management of Dyslipidaemias