An assessment by the Statin Muscle Safety Task Force: 2014 update

J Clin Lipidol. May-Jun 2014;8(3 Suppl):S58-71. doi: 10.1016/j.jacl.2014.03.004.


The National Lipid Association's Muscle Safety Expert Panel was charged with the duty of examining the definitions for statin-associated muscle adverse events, development of a clinical index to assess myalgia, and the use of diagnostic neuromuscular studies to investigate muscle adverse events. We provide guidance as to when a patient should be considered for referral to neuromuscular specialists and indications for the performance of a skeletal muscle biopsy. Based on this review of evidence, we developed an algorithm for the evaluation and treatment of patients who may be intolerant to statins as the result of adverse muscle events. The panel was composed of clinical cardiologists, clinical lipidologists, an exercise physiologist, and a neuromuscular specialist.

Keywords: Muscle adverse events; Myalgia; Myopathy; Neuromuscular testing; Rhabdomyolysis; Statin intolerance; Statins.

Publication types

  • Practice Guideline

MeSH terms

  • Cardiovascular Diseases / complications
  • Cardiovascular Diseases / drug therapy
  • Cardiovascular Diseases / prevention & control*
  • Creatine Kinase / metabolism
  • Evidence-Based Medicine
  • Humans
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors / adverse effects
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors / therapeutic use*
  • Hyperlipoproteinemia Type II / complications
  • Muscle, Skeletal / pathology
  • Muscular Diseases / etiology
  • Muscular Diseases / pathology
  • Myalgia / etiology
  • Myalgia / pathology
  • Vitamin D / blood


  • Hydroxymethylglutaryl-CoA Reductase Inhibitors
  • Vitamin D
  • Creatine Kinase