Statin and Vitamin D: Any Benefits of Combining The Two?

Recently, there has been some discussion on whether correcting low vitamin D could potentially help solve muscular pain that is commonly associated with statins. It is thought that much of the population has vitamin D deficiency due to a lack of sun exposure. The test for vitamin D levels can be expensive so routine analysis is not commonly done unless warranted. Officials with the Institute of Medicine recently concluded that people are at risk of vitamin D deficiency at serum 25(OH)D concentrations <12 ng/mL.¹

Current evidence is mainly observational and no direct correlation for statin-induced muscle pain due to low vitamin D can be made. Lack of quality evidence has provided conflicting information. One study provided information that suggested patients on statin therapy had 21.4% lower increase in vitamin D concentrations than nonusers. ² This was present in patients aged 60 and older. A retrospective cohort study performed by Palamaner et al. concluded that levels of < 15 ng/ml have a high predictive accuracy for statin induced myalgia.³ A systematic review and meta-analysis was performed to assess the effect of statins on vitamin D concentrations. The analysis was inconclusive on the effects due to poor quality of data available and conflicting results.

Vitamin D plays an important role within our body. It helps with absorption of calcium, cell growth, reduction of inflammation, and proper immune function.¹ Adequate vitamin D serum concentration is important for the long-term health of our body. Sun exposure plays an important role in vitamin D synthesis.

Ultraviolet B (UVB) radiation penetrates the skin and converts vitamin D to active metabolite. UVB does not penetrate glass, so indoor exposure to sun may provide warmth, but no vitamin D production. It is hard to say exactly how much sun exposure is needed for proper concentration of vitamin D, but researchers suggest that approximately 5-30 minutes of sun exposure between 10 a.m. and 3 p.m. at least twice weekly to face, legs, arms, or back without sunscreen may lead to adequate vitamin D synthesis.¹ Another source of vitamin D comes from the food we eat though this provides limited amounts. Foods such as fish, yogurt, eggs, beef etc. provide limited amounts of vitamin D.

Evidence regarding low vitamin D and statin related myalgia is currently limited and further randomized controlled trials will be needed to see a direct correlation. It is not out of the realm of possibility that a low vitamin D level could be observed as a predictive valve for statin related myalgia. Some studies have concluded that vitamin D deficiency could predispose patients to statin related myalgia.^3,4 The quality of evidence needs to be considered when assessing results. Patient specific characteristics and statin trial history can help assess the importance of obtaining vitamin D levels to help manage patient therapy.

Reference:

1. Vitamin D. National Institutes of Health. Available at https://ods.od.nih.gov/factsheets/VitaminD-HealthProfessional/ Accessed August 1, 2017. Updated February 11, 2016.

2. Bischoff-Ferrari HA, Fischer K, Orav EJ r et al. Statin Use and 25-Hydroxyvitamin D Blood Level Response to Vitamin D Treatment of Older Adults. J Am Geriatr Soc. 2017 Jun;65(6):1267-1273. doi: 10.1111/jgs.14784. Epub 2017 Feb 27.

3. Palamaner Subash Shantha G, Ramos J, Thomas-Hemak L et al. Association of vitamin D and incident statin induced myalgia--a retrospective cohort study. PLoS One. 2014 Feb 19;9(2):e88877. doi: 10.1371/journal.pone.0088877. eCollection 2014.

4. Taylor BA, Lorson L, White CM et al. Low vitamin D does not predict statin associated muscle symptoms but is associated with transient increases in muscle damage and pain. Atherosclerosis. 2017 Jan;256:100-104. doi: 10.1016/j.atherosclerosis.2016.11.011. Epub 2016 Nov 12.