High dose statin-associated myopathy, rhabdomyolysis and acute kidney injury in Asian ethnic population 

Abstract

Statins are considered to be safe, well tolerated. Severe myopathy and rhabdomyolysis is the most intense adverse effect of statins, which may result in acute kidney injury (AKI), disseminated intravascular coagulation and death. According to recent guidelines treatment with highintensity statins is recommended for primary or secondary prevention of cardiovascular disease. This is a report of three Asian ethnic patients who developed severe myopathy, rhabdomyolysis and AKI due to treatment with high-intensity statin therapy. Though, high-potency statins are more effective in improving cardiovascular outcomes, but there is increased the risk of AKI with their use. Asian experience blood levels of the drug twice as high as non-Asians. This higher blood level could predispose to severe myopathy. Further, there is high prevalence of vitamin D deficiency in this population which synergistically interacts with statins to cause myotoxicity. Unfortunately, the data on the long term safety and efficacy of high dose statin therapy in Asian ethnic population is lacking. These cases highlight the risk of high-intensity statin and make a case for moderate-intensity statin and correction of hypovitaminosis D before instituting statin therapy in Asian ethnic population.  

Keywords: Acute kidney injury, Myopathy, Myotoxicity, Rhabdomyolysis, Statins