Atorvastatin-Associated Myopathy: A Clinical Study in Thi-Qar Province, Iraq
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Statins are lipid-lowering agents broadly prescribed to reduce cardiovascular events; atorvastatin is one of the most used drugs due to its high efficacy. Patients who take statins had muscle related outcomes, an increased risk of cardiovascular events are the most significant causes of statin discontinuation.
This study aims to provide a comprehensive overview of the dual impact of statins, particularly atorvastatin, in the context of cardiovascular therapy and risk of muscle related side effects within Nasiriyah city.
The study is a cross-sectional study was managed at al-Nasiriyah teaching hospital /Nasiriyah Heart Hospital / Specialized Center for Diabetes and Endocrinology in Thi-Qar.
The results indicate that higher statin doses are significantly associated with increased BMI, elevated creatinine, with certain risk factors (older age, gender, smokes, and vitamin D deficiency) that greater incidence of myopathy. The risk of developing myopathy increases with higher doses of the drug and in individuals with certain risk factors, Concomitant use of other medications that affect statin metabolism.
[1] Vaklavas C, Chatzizisis YS, Ziakas A, Zamboulis C, Giannoglou GD. Molecular basis of statin-associated myopathy. Atherosclerosis. 2009. p. 18–28. doi:10.1016/j.atherosclerosis.2008.05.021 PubMed PMID: 18585718.
[2] Willey JZ, Elkind MSV. 3-Hydroxy-3-methylglutaryl–Coenzyme A Reductase Inhibitors in the Treatment of Central Nervous System Diseases. Arch Neurol. 2010;67(9):1062–1067. doi:10.1001/archneurol.2010.199.
[3] Therapeutic agents for the management of atherosclerosis from herbal sources: A computational approach. Global Journal of Basic Science. 2024 Nov 30;1(1):1–24. doi:10.63454/jbs20000004
[4] Janssen L, Allard NAE, Saris CGJ, Keijer J, Hopman MTE, Timmers S. Muscle toxicity of drugs: When drugs turn physiology into pathophysiology. Physiol Rev. 2020 Apr 1;100(2):633–72. doi:10.1152/physrev.00002.2019 PubMed PMID: 31751166.
[5] Shaghaghi Z, Alvandi M, Farzipour S, Dehbanpour MR, Nosrati S. A review of effects of atorvastatin in cancer therapy. Medical Oncology. 2022;40(1):27. doi:10.1007/s12032-022-01892-9
[6] Ruscica M FNBMSCCA. Ruscica M, Ferri N, Banach M, Sirtori CR, Corsini A. Side effects of statins: from pathophysiology and epidemiology to diagnostic and therapeutic implications. Cardiovascular Research. 2022 Dec 1;118(17):3288-304.
[7] Hoste E, Haufroid V, Deldicque L, Balligand JL, Elens L. Atorvastatin-associated myotoxicity: A toxicokinetic review of pharmacogenetic associations to evaluate the feasibility of precision pharmacotherapy. Clinical Biochemistry. Elsevier Inc.; 2024. doi:10.1016/j.clinbiochem.2024.110707 PubMed PMID: 38182100.
[8] Nikolic D, Banach M, Chianetta R, Luzzu LM, Pantea Stoian A, Diaconu CC, et al. An overview of statin-induced myopathy and perspectives for the future. Expert Opinion on Drug Safety. Taylor and Francis Ltd; 2020. p. 601–15. doi:10.1080/14740338.2020.1747431 PubMed PMID: 32233708.
[9] Sathasivam S, Lecky B. Statin induced myopathy. BMJ. 2008. p. 1159–62. doi:10.1136/bmj.a2286 PubMed PMID: 18988647.
[10] Idiopathic inflammatory myopathies. Nature Reviews Disease Primers. Nature Research; 2021. doi:10.1038/s41572-021-00325-7 PubMed PMID: 34857780.
[11] Freedman DS HMBGSA comparison of the S skinfold thickness equations and B in predicting body fatness and cardiovascular disease risk factor levels in children. TA journal of clinical nutrition. 2013 D 1;98(6):1417 24. Freedman DS, Horlick M, Berenson GS. A comparison of the Slaughter skinfold-thickness equations and BMI in predicting body fatness and cardiovascular disease risk factor levels in children. The American journal of clinical nutrition. 2013 Dec 1;98(6):1417-24.
[12] Attardo S, Musumeci O, Velardo D, Toscano A. Statins Neuromuscular Adverse Effects. International Journal of Molecular Sciences. MDPI; 2022. doi:10.3390/ijms23158364 PubMed PMID: 35955495.
[13] Afzal Sohaib S, Finegold JA, Nijjer SS, Hossain R, Linde C, Levy WC, et al. Opportunity to Increase Life Span in Narrow QRS Cardiac Resynchronization Therapy Recipients by Deactivating Ventricular Pacing Evidence From Randomized Controlled Trials. 2015.
[14] Gheorghe G, Toth PP, Bungau S, Behl T, Ilie M, Stoian AP, et al. Cardiovascular risk and statin therapy considerations in women. Diagnostics. Multidisciplinary Digital Publishing Institute (MDPI); 2020. doi:10.3390/diagnostics10070483
[15] Setoguchi S, Glynn RJ, Avorn J, Mittleman MA, Levin R, Winkelmayer WC. Improvements in Long-Term Mortality After Myocardial Infarction and Increased Use of Cardiovascular Drugs After Discharge. A 10-Year Trend Analysis. J Am Coll Cardiol. 2008 Apr 1;51(13):1247–54. doi:10.1016/j.jacc.2007.10.063 PubMed PMID: 18371553.
[16] Afzal Sohaib S, Finegold JA, Nijjer SS, Hossain R, Linde C, Levy WC, et al. Opportunity to Increase Life Span in Narrow QRS Cardiac Resynchronization Therapy Recipients by Deactivating Ventricular Pacing Evidence From Randomized Controlled Trials. 2015.
[17] Nicholls SJ, Tuzcu EM, Sipahi I, Schoenhagen P, Hazen SL, Ntanios F, et al. Effects of Obesity on Lipid-Lowering, Anti-Inflammatory, and Antiatherosclerotic Benefits of Atorvastatin or Pravastatin in Patients With Coronary Artery Disease (from the REVERSAL Study). American Journal of Cardiology. 2006 Jun 1;97(11):1553–7. doi:10.1016/j.amjcard.2005.12.042 PubMed PMID: 16728212.
[18] Chen CW, Chen TC, Huang KY, Chou P, Chen PF, Lee CC. Differential Impact of Statin on New-Onset Diabetes in Different Age Groups: A Population-Based Case-Control Study in Women from an Asian Country. PLoS One. 2013 Aug 12;8(8). doi:10.1371/journal.pone.0071817 PubMed PMID: 23951249.
[19] Stroes ES, Thompson PD, Corsini A, Vladutiu GD, Raal FJ, Ray KK, et al. Statin-associated muscle symptoms: impact on statin therapy - European Atherosclerosis Society Consensus Panel Statement on Assessment, Aetiology and Management. European Heart Journal. Oxford University Press; 2015. p. 1012–22. doi:10.1093/eurheartj/ehv043 PubMed PMID: 25694464.
[20] Li H, Lin H, Zhao H, Xu Y, Cheng Y, Shen P, et al. Statins use and risk of new-onset diabetes in hypertensive patients: A population-based retrospective cohort study in Yinzhou district, Ningbo city, People’s Republic of China. Ther Clin Risk Manag. 2018 May 3;14:823–32. doi:10.2147/TCRM.S158850
[21] Horodinschi RN, Stanescu AMA, Bratu OG, Stoian AP, Radavoi DG, Diaconu CC. Treatment with statins in elderly patients. Medicina (Lithuania). MDPI AG; 2019. doi:10.3390/medicina55110721 PubMed PMID: 31671689.
[22] Sattar N, Preiss D, Murray HM, et al. Statins and risk of incident diabetes: a collaborative meta-analysis of randomised statin trials. 2010. In: Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet]. York (UK): Centre for Reviews and Dissemination (UK); 1995-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK78906/.
[23] Stroes ES, Thompson PD, Corsini A, Vladutiu GD, Raal FJ, Ray KK, et al. Statin-associated muscle symptoms: impact on statin therapy - European Atherosclerosis Society Consensus Panel Statement on Assessment, Aetiology and Management. European Heart Journal. Oxford University Press; 2015. p. 1012–22. doi:10.1093/eurheartj/ehv043 PubMed PMID: 25694464.
[24] Reiter-Brennan C, Dzaye O, Davis D, Blaha M, Eckel RH. Comprehensive Care Models for Cardiometabolic Disease. DIABETES AND CARDIOVASCULAR DISEASE. doi:10.1007/s11886-021-01450-1/Published
[25] Abd TT, Jacobson TA. Statin-induced myopathy: A review and update. Expert Opinion on Drug Safety. 2011. p. 373–87. doi:10.1517/14740338.2011.540568 PubMed PMID: 21342078.
[26] Ruscica M, Ferri N, Banach M, Sirtori CR, Corsini A. Side effects of statins: from pathophysiology and epidemiology to diagnostic and therapeutic implications. Cardiovasc Res. 2022 Dec 1;118(17):3288–304. doi:10.1093/cvr/cvac020 PubMed PMID: 35238338.
[27] Skilving I, Eriksson M, Rane A, Ovesjö ML. Statin-induced myopathy in a usual care setting—a prospective observational study of gender differences. Eur J Clin Pharmacol. 2016 Oct 1;72(10):1171–6. doi:10.1007/s00228-016-2105-2 PubMed PMID: 27484241.
[28] Mariam Molokhia1* PMVCAM. Molokhia, M., McKeigue, P., Curcin, V., & Majeed, A. (2008). Statin induced myopathy and myalgia: time trend analysis and comparison of risk associated with statin class from 1991-2006. PloS one, 3(6), e2522. https://doi.org/10.1371/journal.pone.0002522.
[29] Abed W, Abujbara M, Batieha A, Ajlouni K. Statin Induced Myopathy Among Patients Attending the National Center for Diabetes, endocrinology, & genetics. Annals of Medicine and Surgery. 2022 Feb 1;74:103304. doi:10.1016/J.AMSU.2022.103304
[30] Manoj K, Jain N, Madhu SV. Myopathy in Patients Taking Atorvastatin: A Pilot Study. Indian J Endocrinol Metab. 2017 Jul-Aug;21(4):504-509. doi: 10.4103/ijem.IJEM_79_17. PMID: 28670530; PMCID: PMC5477434.
[31] Cholesterol Treatment Trialists’ (CTT) Collaborators, Mihaylova B, Emberson J, et al. The effects of lowering LDL cholesterol with statin therapy in people at low risk of vascular disease: meta-analysis of individual data from 27 randomised trials. Lancet (London, England). 2012 Aug;380(9841):581-590. DOI: 10.1016/s0140-6736(12)60367-5. PMID: 22607822; PMCID: PMC3437972.
[32] Thompson PD CPKRH. Thompson PD, Clarkson P, Karas RH. Statin-Associated Myopathy. JAMA. 2003;289(13):1681–1690. doi:10.1001/jama.289.13.1681. 2003.
[33] Marcum ZA, Vande Griend JP, Linnebur SA. FDA drug safety communications: A narrative review and clinical considerations for older adults. American Journal of Geriatric Pharmacotherapy. 2012. p. 264–71. doi:10.1016/j.amjopharm.2012.05.002 PubMed PMID: 22683398.
[34] Littmann K, Wodaje T, Alvarsson M, Bottai M, Eriksson M, Parini P, Brinck J. The association of lipoprotein (a) plasma levels with prevalence of cardiovascular disease and metabolic control status in patients with type 1 diabetes. Diabetes care. 2020 Aug 1;43(8):1851-8.
[35] Musumeci, O., & Drago, S. F. A. (2025). Update on statin-associated myopathy symptoms in the view of new clinical management strategies. Current opinion in neurology, 38(5), 551–559. https://doi.org/10.1097/WCO.0000000000001405.
[36] Reith C BLEJPDSEDKHHHCHLWKHR. Reith C, Blackwell L, Emberson JR, Preiss D, Spata E, Davies K, Halls H, Harper C, Holland L, Wilson K, Humphrey R. Assessment of adverse effects attributed to statin therapy in product labels: a meta-analysis of double-blind randomised controlled trials. The Lancet. 2026 Feb 14;407(10529):689-703.
[37] Kulmala J. Lifespan and Skeletal Muscle Properties The Effects of Genetic Background, Physical Activity and Aging Sira Karvinen.
[38] Manoj K, Jain N, Madhu S V. Myopathy in patients taking atorvastatin: A pilot study. Indian J Endocrinol Metab. 2017 Jul 1;21(4):504–9. doi:10.4103/ijem.IJEM_79_17
[39] Epelde F. Statin-Associated Muscle Symptoms and Myotoxicity: A Clinically Oriented Narrative Review with a Practical Prevention, Evaluation, and Management Algorithm. Medicina (Lithuania). Multidisciplinary Digital Publishing Institute (MDPI); 2026. doi:10.3390/medicina62061134
[40] Stroes ES TPCAVGRFRKRMSETLNBBE. Stroes ES, Thompson PD, Corsini A, Vladutiu GD, Raal FJ, Ray KK, Roden M, Stein E, Tokgözoğlu L, Nordestgaard BG, Bruckert E. Statin-associated muscle symptoms: impact on statin therapy—European Atherosclerosis Society consensus panel statement on assessment, aetiology and management. European heart journal. 2015 May 1;36(17):1012-22.

