Spectrum of statin-associated muscle adverse events

Term	Clinical findings	Histopathological findings^[1]
Myalgia	Unexplained muscle discomfort often described as "flu-like" symptoms with normal CK level The spectrum of myalgia complaints includes: Muscle aches; Muscle soreness; Muscle stiffness; Muscle tenderness; and Muscle cramps with or shortly after exercise (not nocturnal cramping)	None
Myopathy	Muscle weakness (not attributed to pain and not necessarily associated with elevated CK)	Variable findings: Atrophy Inflammation Mitochondrial changes
Myositis	Muscle inflammation	T cells > B cells; macrophages
Myonecrosis	Muscle enzyme elevations or hyperCKemia Mild: >3-fold greater than baseline untreated CK levels or normative upper limit that are adjusted for age, race, and sex Moderate: ≥10-fold greater than untreated baseline CK levels or normative upper limit that are adjusted for age, race, and sex Severe: ≥50-fold above baseline CK levels or normative upper limit that are adjusted for age, race, and sex	Non-specific inflammatory cells with secondary macrophage infiltration
Myonecrosis with myoglobinuria (rhabdomyolysis)	Increase in serum creatinine ≥0.5 mg/dL (clinical rhabdomyolysis)	Non-specific inflammatory cells with secondary macrophage infiltration

CK: creatine kinase.

References:

Brunham LR, Baker S, Mammen A, et al. Role of genetics in the prediction of statin-associated muscle symptoms and optimization of statin use and adherence. Cardiovasc Res 2018; 114:1073.

Original table modified for this publication. From: Rosenson RS, Baker SK, Jacobson TA, et al. An assessment by the Statin Muscle Safety Task Force: 2014 update. J Clin Lipidol 2014; 8:S58. Table used with the permission of Elsevier Inc. All rights reserved.

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Spectrum of statin-associated muscle adverse events