Abstract 12689: Association of Vitamin D and Incident Statin Induced Myalgia: A Retrospective Cohort Study
Introduction: Evidence is conflicting with regards to the role of vitamin D in statin induced myalgia (SIM). These studies predominantly assessed cross-sectional association and were limited by study sample selected from cardiology clinics. In this retrospective cohort study involving a large sample, unselected attendees from a primary care practice, we attempted to assess the association between vitamin D and incident SIM and establish a clinically applicable serum vitamin D cutoff to identify patients at risk.
Methods: Case records of 5526 consecutive adult attendees at a primary care practice in Scranton, Pennsylvania, from 2005 - 2012 were reviewed. Vitamin D level (25-hydroxy cholecalciferol) at statin initiation was considered exposure. Vitamin D levels were categorized into quartiles (≤10, 11 - 20, 21 - 30, > 30). Statin induced myalgia was identified by patient report. Cox proportional hazards regression was performed to assess the association between vitamin D and incident SIM.
Results: The mean age was 55.9 years. The population was 45.1% male and 12.8% black. During a median follow-up period of 4.2 years (range: 2.3 - 5.6), there were 1160 statin users (21%) and 276 (24%) among them developed SIM. The unadjusted 7-yr cumulative incidences across quartiles 1-4 of vitamin D concentration were 32.3, 21.5, 18.3 and 14.6%. After adjustment for traditional cardiovascular risk factors, the first quartile of vitamin D was associated with 1.21 times the hazard of the fourth quartile (95% CI: 1.09, 1.33; P-trend = 0.001). Vitamin D cut-off ≤ 15 mg/dl, showed a sensitivity, specificity, positive predictive value, negative predictive value, area under the curve, likelihood ratio (LR) + and LR- of 83, 85, 90, 70, 78, 4.8 and 0.2, respectively in predicting incident SIM.
Conclusion: Low vitamin D at statin initiation is associated with SIM and levels ≤ 15 mg/dl have a high predictive accuracy. Future studies are necessary to elucidate the mechanism underlying this association.
- © 2013 by American Heart Association, Inc.