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    ABSTRACT: The National Lipid Association's Muscle Safety Expert Panel was charged with the duty of examining the definitions for statin-associated muscle adverse events, development of a clinical index to assess myalgia, and the use of diagnostic neuromuscular studies to investigate muscle adverse events. We provide guidance as to when a patient should be considered for referral to neuromuscular specialists and indications for the performance of a skeletal muscle biopsy. Based on this review of evidence, we developed an algorithm for the evaluation and treatment of patients who may be intolerant to statins as the result of adverse muscle events. The panel was composed of clinical cardiologists, clinical lipidologists, an exercise physiologist, and a neuromuscular specialist.
    Journal of Clinical Lipidology 05/2014; 8(3 Suppl):S58-71. DOI:10.1016/j.jacl.2014.03.004 · 3.59 Impact Factor
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    ABSTRACT: Statins are the backbone of lipid-lowering therapy in the prevention of cardiovascular disease. Numerous studies have evaluated the effect of genomics on the clinical efficacy and adverse effects of statins. Several gene variants, which can be linked to either the pharmacokinetics or pharmacodynamics of statins, have been identified as potentially important, although there are some discrepant findings among studies. Effect sizes are modest for lipid-lowering efficacy, and perhaps somewhat larger for risk of myopathy, although results are inconsistent. Pharmacogenomics of non-statin lipid-lowering agents have not been evaluated to the same extent given their relatively limited use, although there are some promising candidate genes for further study. Finally, with several new classes of lipid-lowering therapies soon becoming available, there may be a potential application for pharmacogenomics to identify patients ideally suited to receive - or those who should avoid - specific medications.Clinical Pharmacology & Therapeutics (2014); Accepted article preview online 10 April 2014. doi:10.1038/clpt.2014.82.
    Clinical Pharmacology &#38 Therapeutics 04/2014; 96(1). DOI:10.1038/clpt.2014.82 · 7.39 Impact Factor
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    ABSTRACT: Introduction: Cardiovascular disease (CVD) remains the leading cause of death in industrialized nations. Despite clear evidence of CVD risk reduction with HMG-CoA reductase inhibitors (statins), the side effects of these medications, particularly myopathy, limit their effectiveness. Studies into the mechanisms, aetiology and management of statin myopathy are limited by lack of an internationally agreed clinical definition and tools for assessing outcomes. Currently there is a paucity of evidence to guide the management of patients affected by statin myopathy; with the exception of dose reduction, there is little evidence that other strategies can improve statin tolerance, and even less evidence to suggest these alternate dosing strategies reduce cardiovascular risk.Areas covered: This review will cover current definitions, clinical presentations, risk factors, pathogenesis and management. PubMed was searched (English language, to 2014) for key articles pertaining to statin myopathy. This review then briefly describes our experience of managing this condition in a tertiary lipid disorders clinic, in the setting of limited guiding evidence.Expert opinion: Knowledge gaps in the field of statin myopathy are identified and future research directions are suggested. We urge the need for international attention to address this important, but largely neglected clinical problem, that if unresolved will remain an impediment to the effective prevention and treatment of CVD.
    Expert Opinion on Drug Safety 07/2014; 13(9). DOI:10.1517/14740338.2014.937422 · 2.74 Impact Factor