Statins & Vitamin D

In a recent meta-analysis of 9 cohort studies that included a total of nearly 3,000 participants, the relationship between 25-OH vitamin D (25-OHD) plasma levels and statin-associated myopathy was examined, as well as the effect of vitamin D supplementation on statin intolerance. Given that 10-25% of statin users report muscle-associated symptoms, and that over 60% of those that stopped statin therapy did so because of side effects, any benefit to raising vitamin D levels could be very clinically significant.

The meta-analysis revealed that the 25-OHD plasma level of participants with statin-related myopathy was significantly lower than those of participants without statin-related muscular adverse events. Additionally, re-challenge with statin therapy (after discontinued use due to side effects) was more successful following vitamin D supplementation (in participants with low vitamin D levels). Indeed, the pooled tolerance rate was nearly 90% following vitamin D supplementation.

Although this meta-analysis was not designed to determine causality, several mechanisms were suggested, related to the role of cholesterol in vitamin D biosynthesis, as well as the physiological effects of vitamin D on skeletal muscle and/or the influence of vitamin D on statin metabolism. Regardless of the mechanism, this suggests that a determination of 25-OHD status before beginning statin therapy should be considered, and that supplementation is very likely to help with statin tolerance in those with insufficient vitamin D status and statin intolerance.