Abstract
Statins reduce arterial stiffness but are also associated with mild muscle complaints. It is unclear whether individuals with muscle symptoms experience the same vascular benefit or whether statins affect striated and smooth muscle cells differently. We examined the effect of simvastatin treatment on arterial stiffness in patients who did versus those who did not exhibit muscle symptoms. Patients with a history of statin-related muscle complaints (n = 115) completed an 8 wk randomized, double-blind, cross-over trial of daily simvastatin 20 mg and placebo. Serum lipids and pulse wave velocity (PWV) were assessed before and after each treatment. Muscle symptoms with daily simvastatin treatment were reported by 38 patients (33%). Compared to baseline, central PWV decreased (P = 0.01) following simvastatin treatment but not placebo (drug ∗ time interaction: P = 0.047). Changes in central PWV with simvastatin treatment were not influenced by myalgia status or time on simvastatin (P ≥ 0.15). Change in central PWV after simvastatin treatment was inversely correlated with age (r = −0.207, P = 0.030), suggesting that advancing age is associated with enhanced statin-mediated arterial destiffening. In patients with a history of statin-related muscle complaints, the development of myalgia with short-term simvastatin treatment did not attenuate the improvement in arterial stiffness.
Highlights
Hydroxy-methylglutaryl-coenzyme A (HMG-CoA) reductase inhibitors inhibit mevalonate production, effectively reducing low-density lipoprotein- (LDL-) cholesterol concentrations
Statins are associated with multiple vascular benefits [1, 2] that may contribute to reduced cardiovascular disease (CVD) morbidity and mortality [3,4,5]
The present investigation examined the effect of simvastatin treatment on pulse wave velocity (PWV) in patients who did versus those who did not exhibit statin-associated muscle symptoms during the run-in phase of the Co-Enzyme Q10 in Statin Myopathy study, of which the methods have been described in detail [11, 12]
Summary
Hydroxy-methylglutaryl-coenzyme A (HMG-CoA) reductase inhibitors (statins) inhibit mevalonate production, effectively reducing low-density lipoprotein- (LDL-) cholesterol concentrations. Reductions in central arterial stiffness (assessed noninvasively by arterial pulse wave velocity (PWV)) with statin use [6,7,8,9,10] represent one such vascular benefit. Statins are well-tolerated but can produce mild muscle complaints such as muscle pain (myalgia), cramps, weakness, and stiffness. It is not known whether patients who exhibit muscle symptoms with statin use demonstrate the same improvement in central arterial stiffness as nonmyalgic patients. The present investigation examined the effect of simvastatin treatment on PWV in patients who did versus those who did not exhibit statin-associated muscle symptoms during the run-in phase of the Co-Enzyme Q10 in Statin Myopathy study, of which the methods have been described in detail [11, 12]
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