Which of the following statements regarding statin (HMG-CoA reductase inhibitor) therapy is false?

Which Statement About Statin Therapy is FALSE?

Statement D is FALSE: If persistent muscle symptoms are determined to be unrelated to statin therapy, the American College of Cardiology explicitly recommends that statins should be continued or reinitiated since the symptoms are not caused by the statin. 1

Analysis of Each Statement

Statement A: Statins and Pregnancy (TRUE)

• Statins are contraindicated in pregnancy due to teratogenic potential 2
• The FDA labeling explicitly lists pregnancy as a contraindication 2
• Females of reproductive potential should use effective contraception during statin treatment 2

Statement B: Baseline ALT Measurement (TRUE)

• Liver enzyme testing, including ALT, should be performed before initiating statin therapy 3
• The monitoring protocol includes evaluation initially, at 12 weeks, and then annually 3
• Active liver disease or unexplained persistent elevations of serum transaminases are contraindications to statin therapy 2

Statement C: Management of Moderate Muscle Pain (TRUE)

• When patients develop moderate muscle pain on statin therapy, the correct approach is to discontinue the statin, evaluate for other causes, then consider reinitiating at a lower dose or the original dose 1
• After resolution of symptoms, patients can usually be treated with a statin without harm, though with careful monitoring 1
• If symptoms are caused by the statin, discontinue it, evaluate for other causes, and consider rechallenge at a lower dose 1

Statement D: Persistent Muscle Symptoms Unrelated to Statin (FALSE)

• This statement directly contradicts guideline recommendations 1
• The American College of Cardiology specifically states that if persistent muscle symptoms are determined to be unrelated to statin therapy, statins should be continued or reinitiated since the symptoms are not caused by the statin 1
• The statement incorrectly suggests avoiding statin therapy when symptoms are proven to be unrelated to the statin

Clinical Context on Muscle Symptoms

Actual Incidence of Statin-Related Muscle Symptoms

• In randomized controlled trials, the difference in muscle symptoms between statin and placebo groups is less than 1% 4
• Only one in 15 muscle-related reports by participants allocated to statin therapy were actually due to the statin 5
• More than 90% of all reports of muscle symptoms by participants taking statins were not due to the statin 5

Key Clinical Pitfall

• In clinical practice, roughly 10% of patients stop taking statins due to subjective muscle complaints, but the actual pharmacological effect accounts for less than 1% of these symptoms 4
• This discrepancy highlights the importance of proper evaluation to determine whether symptoms are truly statin-related before discontinuing life-saving therapy 1, 4