Unveiling Barriers and Investigating the Influence of High-Intensity Therapy on Statin-Induced Myalgia and Intolerance

We used the statin-associated muscle symptom clinical index (SAMS-CI) to evaluate misconceptions among cardiologists regarding the use of high-intensity statins (HIS) in relation to intolerance, including myalgia, and to determine the occurrence of HIS-induced myalgia in patients with acute coronary syndrome (ACS).
 

The present observational cohort study, performed in a tertiary care cardiac hospital in Karachi, Pakistan, consisted of 2 phases. Phase 1 involved an online survey among practicing cardiologists to identify obstacles to HIS prescription. The second phase involved observing 418 ACS patients who underwent HIS therapy. Myalgia was assessed using the SAMS-CI and categorized as unlikely (2–6), possible (7–8), or probable (9–11) cases of myalgia.
 

In the first phase, 77.8% (35/45) of physicians favored prescribing HIS therapy. However, the commonly perceived barriers were myalgia (31%), tolerability (29%), and affordability (22%). In the second phase, 418 patients were included. Among them, 19 patients (4.54%) experienced muscle symptoms based on the SAMS-CI score. Subsequently, 5 patients were classified as unlikely and continued the same dosage, while 6 patients were categorized as possible, leading to a reduction in dosage to moderate intensity. Consequently, their symptoms were resolved, and they continued the moderate-intensity regimen. Statin use was discontinued for the remaining 8 patients in the probable category for 4 weeks until the symptoms resolved, after which moderate-intensity statins were resumed.
 

Most patients tolerated a lower targeted dose of HIS without experiencing objective symptoms. Therefore, we confidently conclude that a lower targeted dose of HIS is generally well tolerated in the ACS setting and should be considered by physicians.