Muscle pain and serum creatine kinase are not associated with low serum 25(OH) vitamin D levels in patients receiving statins

Objective Vitamin D deficiency has been associated in some studies with nonspecific musculoskeletal pain and, more specifically, with statin-induced myalgia, which was ameliorated by high-dose vitamin D supplements. Our objective was to explore the association between vitamin D status and statin-induced myalgia and elevation of serum creatine kinase (CK). Design Retrospective cohort study, based on the electronic database of a health maintenance organization. Patients Six thousand eight hundred and eight patients (71.5% women) to whom statins were dispensed during 2008 and who had =1 CK and 25-hydroxy vitamin D (25OHD) levels measured during statin exposure. Of these, 376 patients (5.5%) had switched from a first-line statin to atorvastatin because of muscle pain (n = 220) or other reasons (n = 156). Measurements In the entire cohort, we compared serum CK levels among serum 25OHD quartiles. In addition, we compared CK and 25OHD levels among patients with myalgia, other switchers and nonswitchers. Results The median 25OHD level in the entire cohort was 21.8 ng/ml [interquartile range (IQR), 16.327.4]. CK levels were marginally lower in patients in the lowest 25OHD quartile [median CK (IQR) in 25OHD quartiles 14, 87 (61130), 90 (65131), 91 (65132) and 91 (67131) IU/ml, respectively; P = 0.007]. 25OHD levels in statin switchers were similar to those in nonswitchers; moreover, there were no differences in 25OHD among switchers with muscle pain and other switchers. Conclusion Our findings do not support an association between low 25OHD levels and statin-induced myalgia or CK elevation.