Vitamin D Supplementation Increases Statin Tolerance

When taken consistently, statins reduce the risk of cardiovascular heart disease and cardiovascular death. Major barriers that prevent patients from receiving the maximum benefit are nonadherence, or discontinuation because of adverse events. Myalgia and rhabdomyolysis have both been associated with all the drugs in this class, with myopathy rates as high as 10%.

Researchers have published a single center retrospective study that looked at patients with low vitamin D levels who had previously developed myalgia on statins. The study—which appears in the Journal of Pharmacy Practice—asked if vitamin D supplementation could help patients restart statin therapy and avoid myalgia.

The researchers administered participants a loading dose of ergocalciferol, 50,000 units per week for 8 to 12 weeks, followed by a maintenance dose of cholecalciferol, 800 to 1000 units daily. Participants re-started statins at around 6 months, with choice of medication, dosage, and frequency based on current clinical practice and patient preference. Some participants took their statins every other day if the specific statins had long half-lives.

Prescribers used atorvastatin, pravastatin, and rosuvastatin most often. They employed intermittent dosing frequency in 40% of the participants. All 27 patients in the study were able to maintain their statin therapy without myalgia complaints at the end of the 12-month study.

Six participants were able to tolerate an appropriate ACC/AHA 2013 Cholesterol Treatment Guideline regimen; this is considered aggressive therapy, and a remarkable achievement. When the researchers used the National Lipid Association 2014 guideline, 8 out of 8 patients achieved the LDL and non-HDL goal, respectively.

Eleven patients were able to tolerate a statin they had previously failed.

The majority of patients that met the lipid goals had achieved goal serum vitamin D levels.

This trial suggests that patients with vitamin D deficiencies who cannot tolerate statin therapy because of myalgia may still be candidates to receive statins. After proper vitamin D supplementation, patients may be able to tolerate dosing as aggressive as that recommended in the ACC/AHA 2013 Cholesterol Treatment Guidelines.

Reference

Kang JH, Nguyen QN, Mutka J, Le QA. Rechallenging statin therapy in veterans with statin-induced myopathy post vitamin D replenishment. J Pharm Pract. 2016; pii: 0897190016674407. [Epub ahead of print].