We found a match
Your institution may have rights to this item. Sign in to continue.
- Title
The Risk for Significant Creatine Kinase Elevation with Statins.
- Authors
Stolcpart, Ryan S.; Olson, Kari L.; Delate, Thomas; Rasmussen, Jon; Rehring, Thomas F.; Merenich, John A.
- Abstract
Background: The HMG-CoA reductase inhibitors (statins) are effective for reducing long-term cardiovascular morbidity and mortality in both primary and secondary prevention. The most serious adverse reaction is significant elevation of creatine kinase (CK) leading to rhabdomyolysis. The incidence of CKelevation is low in randomized, controlled trials. The rate may be higher in 'real-world', less controlled settings. Data on the risks of statin-associated rhabdomyolysis in 'real-world' practice settings are limited. Objective: The aim of this study was to examine the risk for CK elevation among statin users in a clinical practice setting. Potential risk factors were identified and evaluated to quantify the risk for CK elevation with statins. Methods: This case-control study was conducted at Kaiser Permanente Colorado. Patients with prescriptions for lovastatin or simvastatin between 1 January 1999 and 30 June 2006 were identified. Cases (n = 183), i.e. patients with a CK ≥10× the upper limit of normal (ULN) while receiving a statin during this time period, were each matched on the date of statin purchase to ten control patients (n = 1830) without CK ≥10×ULN while receiving a statin. Multivariate, conditional logistic regression was used to assess the associations between the statin, statin dose, demographic, co-morbidity, laboratory, and medication factors potentially associated with CK≥10×ULN. Results: The mean (SD) age of patients was 64.9 (11.5) years and 56.9% were male. Overall, simvastatin use was associated with a higher likelihood for CK ≥10×ULN than lovastatin (adjusted odds ratio [OR] 4.6; 95% CI 1.1, 12.4). Using simvastatin 40mg daily as the referent, and in the absence of interacting medications, only simvastatin 80mg was associated with a higher likelihood for CK ≥10×ULN (OR 2.7; 95%CI 1.1, 6.9). In the presence of interacting medications, all doses of simvastatin and only lovastatin 80mg were associated with a higher likelihood for CK ≥10×ULN. Conclusion: In this study, simvastatin was associated with a higher likelihood for CK ≥10×ULN than lovastatin. High-dose simvastatin, in particular, appears to confer a greater risk than lower doses of either simvastatin or lovastatin.
- Subjects
COLORADO; ANALYSIS of variance; ANTILIPEMIC agents; COMPUTER software; CONFIDENCE intervals; CREATINE kinase; ENZYME inhibitors; EPIDEMIOLOGY; GLOMERULAR filtration rate; RESEARCH funding; RHABDOMYOLYSIS; STATISTICS; STATINS (Cardiovascular agents); LOGISTIC regression analysis; DATA analysis; ALANINE aminotransferase; CASE-control method; DRUG dosage
- Publication
American Journal of Cardiovascular Drugs, 2010, Vol 10, Issue 3, p187
- ISSN
1175-3277
- Publication type
Article
- DOI
10.2165/11536130-000000000-00000