How VITAL is Vitamin D in Preventing Statin-Associated Muscle Symptoms (SAMS)?

Authors:
Rick Hess, PharmD, CDCES, BCACP

Reviewers:
Dawn Fuke, PharmD, BCPS
Sarah L. Anderson, PharmD, BCACP, BCPS

Citation:
Hlatky MA, Gonzalez PE, Manson JE, et al. Statin-Associated Muscle Symptoms Among New Statin Users Randomly Assigned to Vitamin D or Placebo. JAMA Cardiol. 2023; 8(1): 74-80. doi:10.1001/jamacardio.2022.4250

The Problem

If you are like me, you’ve probably encountered many patients who have experienced muscle symptoms after starting a statin.  What strategies do you recommend to increase statin tolerance? Statin-associated muscle symptoms (SAMS) contribute to treatment discontinuation and significantly increase cardiovascular (CV) adverse events and mortality.¹  SAMS includes “all muscle symptoms temporally related to statin use but without regard to causality”.²  It’s very common —prevalence rates in clinical trials have ranged from 5% to 25%.²   The mechanisms for SAMS are likely multifactorial, but some have postulated that low vitamin D levels are a contributing factor.³  The diagnosis of hypovitaminosis D requires an office visit and lab work, but given that vitamin D is readily available over the counter, very inexpensive, and the risk of overtreatment leading to toxicity is very low, should vitamin D supplementation be given to all patients beginning a statin?