Statin treatment shown to mask the benefits of omega 3 fatty acids with regard to reduced mortality due to cardiovascular disease

A new clinical trial by Khayznikov et al. has found that patients with low serum vitamin D levels that are exhibiting intolerance to statin therapy can be treated for the intolerance by restoring normal serum vitamin D levels by supplementation. Statins are widely, and very successfully, used to reduce blood cholesterol levels in patients with cardiovascular disease or at risk of it. Up to a fifth of people requiring statins will have some form of intolerance, often in the form of muscle pain or memory problems.

Statins are a class of cholesterol lowering drugs. They work by inhibiting the enzyme HMG-CoA reductase, which normally plays a major role in the production of cholesterol. Statins are very widely prescribed by physicians because high cholesterol levels are strongly associated with Cardiovascular Disease (CVD). In the OEDC (Organisation for Economic Development and Cooperation) countries, an average of 9% were prescribed in 2011, with the highest levels being in Australia (13.7%), UK (13%) and Slovakia (13%) respectively (2). Up to 20% of patients taking statins can suffer from some form of side effects, most commonly muscle ache and memory disturbance.

Low blood serum kevels of vitamin D can cause problems with muscles including myalgia, myositis and myopathy (1). These are similar issues facing many patients with intolerance of statins. It is logical that people with low vitamin D levels would be particularly susceptible to muscle pain related statin intolerance. A very recent meta-analysis of seven studies with 2420 statin-treated patients (3) provides evidence that low vitamin D levels are associated with muscle pain in patients on statin therapy.

Khayznikov et al. (1) found that if statin intolerant patients with low serum vitamin D levels (˂ 32ng/mL) were treated with a weekly total vitamin D therapy dose of 50,000 to 100,000 IU/week, the muscle related problems could be resolved in around 9 out of 10 cases.

However, the effect may depend on the type of statin. Backes et al (4) reported that replenishment of vitamin D deficient patients intolerant to rosuvastatin to a minimum serum level of 30ng/mL only produced alleviation of muscle pain related intolerance in 53% of cases.