Which Statement About Statin Therapy is FALSE?
Option D is FALSE: If persistent muscle symptoms are determined to be unrelated to statin therapy, it is recommended to CONTINUE (not avoid) statin therapy, given the significant cardiovascular benefits. 1
Analysis of Each Statement
Statement A: Statins Should Be Avoided in Pregnancy (TRUE)
- Statin therapy is contraindicated in pregnancy due to potential teratogenic effects 1
- This is a well-established contraindication that should be strictly observed 1
Statement B: Baseline ALT Measurement Required (TRUE)
- The American College of Cardiology recommends baseline measurement of hepatic transaminase levels (ALT) before initiation of statin therapy, with Level B evidence rating 1
- This baseline assessment is standard practice before starting statin therapy 2, 3
Statement C: Management of Moderate Muscle Pain (TRUE)
- When patients develop moderate muscle pain on statin therapy, the appropriate approach is to discontinue the statin temporarily and evaluate for other causes 4
- After evaluation, reinitiation at a lower dose or the original dose is appropriate, depending on the clinical scenario 4
- Most muscle symptoms attributed to statins are actually unrelated to the medication—only 1 in 15 muscle-related reports are actually caused by the statin 5
- In randomized controlled trials, the difference in muscle symptoms between statin and placebo groups is less than 1% 6
Statement D: Avoid Statins if Symptoms Unrelated (FALSE - This is the Answer)
- The American College of Cardiology explicitly recommends CONTINUING statin therapy when symptoms are determined to be unrelated to statins, given their significant cardiovascular benefits 1
- This statement directly contradicts evidence-based guidelines 1
- The cardiovascular benefits of statins greatly outweigh the risks, with a 25% reduction in major vascular events per mmol/L LDL reduction 7
- Stopping statins unnecessarily due to misattributed symptoms can lead to preventable heart attacks and strokes 7
Clinical Implications
The key pitfall is misattribution of symptoms to statins:
- Over 90% of muscle symptoms reported by patients on statins are not actually caused by the medication 5
- In placebo-controlled trials, only 0.1% of patients discontinued due to muscle symptoms actually attributable to the statin 6
- Exaggerated concerns about side effects lead to under-use of statins in high-risk patients who would benefit 7
When symptoms are proven unrelated to statin therapy, continuation is essential to maintain cardiovascular protection, as the benefits (preventing 1000 major vascular events per 10,000 patients treated for 5 years in secondary prevention) far exceed the risks (5 cases of myopathy per 10,000 patients over 5 years) 7.