Pathophysiology Behind Statins and Rhabdomyolysis

In addition to their cholesterol-lowering activity, statins can alter the synthesis of some proteins and enzymes within skeletal muscle cells that are responsible for the proper metabolism and functioning of the tissue. Researchers are not sure what exactly causes the muscle damage and breakdown (rhabdomyolysis) but a recent study has shown that the protein product of a specific gene, atrogin-1, plays an important role in the muscle toxicity of statins. In several model systems, lovastatin (a generic statin) was found to induce the expression of the atrogin-1 gene.

Fast Facts:

  • Almost half of Americans over 50 years of age are prescribed statin drugs.
  • Muscle biopsies of some patients with statin-induced muscle weakness and pain actually demonstrate structural injury to the muscle cells, even in patients without elevated levels of creatine phosphokinase.
  • The atrogin-1 gene is apparently also turned on in other conditions where there is muscle wasting such as cancer, AIDS, and kidney disease.
  • Recent research indicates that some individuals may be inherently more susceptible to muscle damage by statins.
  • One day a genetic test might become available that will indicate if a person will be susceptible to statin-induced muscle damage.