Statin and Vitamin D: Any Benefits of Combining The Two?
There has been some recent discussion about whether using vitamin D with statin therapy may help alleviate the muscle pain experienced by some patients
Recently, there has been some discussion on whether correcting low vitamin D could potentially help solve muscular pain that is commonly associated with statins. It is thought that much of the population has vitamin D deficiency due to a lack of sun exposure. The test for vitamin D levels can be expensive so routine analysis is not commonly done unless warranted. Officials with the Institute of Medicine recently concluded that people are at risk of vitamin D deficiency at serum 25(OH)D concentrations <12 ng/mL.1
Current evidence is mainly observational and no direct correlation for statin-induced muscle pain due to low vitamin D can be made. Lack of quality evidence has provided conflicting information. One study provided information that suggested patients on statin therapy had 21.4% lower increase in vitamin D concentrations than nonusers. 2 This was present in patients aged 60 and older. A retrospective cohort study performed by Palamaner et al. concluded that levels of < 15 ng/ml have a high predictive accuracy for statin induced myalgia.3 A systematic review and meta-analysis was performed to assess the effect of statins on vitamin D concentrations. The analysis was inconclusive on the effects due to poor quality of data available and conflicting results.
Vitamin D plays an important role within our body. It helps with absorption of calcium, cell growth, reduction of inflammation, and proper immune function.1 Adequate vitamin D serum concentration is important for the long-term health of our body. Sun exposure plays an important role in vitamin D synthesis.
Ultraviolet B (UVB) radiation penetrates the skin and converts vitamin D to active metabolite. UVB does not penetrate glass, so indoor exposure to sun may provide warmth, but no vitamin D production. It is hard to say exactly how much sun exposure is needed for proper concentration of vitamin D, but researchers suggest that approximately 5-30 minutes of sun exposure between 10 a.m. and 3 p.m. at least twice weekly to face, legs, arms, or back without sunscreen may lead to adequate vitamin D synthesis.1 Another source of vitamin D comes from the food we eat though this provides limited amounts. Foods such as fish, yogurt, eggs, beef etc. provide limited amounts of vitamin D.
Evidence regarding low vitamin D and statin related myalgia is currently limited and further randomized controlled trials will be needed to see a direct correlation. It is not out of the realm of possibility that a low vitamin D level could be observed as a predictive valve for statin related myalgia. Some studies have concluded that vitamin D deficiency could predispose patients to statin related myalgia.3,4 The quality of evidence needs to be considered when assessing results. Patient specific characteristics and statin trial history can help assess the importance of obtaining vitamin D levels to help manage patient therapy.
1. Vitamin D. National Institutes of Health. Available at https://ods.od.nih.gov/factsheets/VitaminD-HealthProfessional/ Accessed August 1, 2017. Updated February 11, 2016.
2. Bischoff-Ferrari HA, Fischer K, Orav EJ r et al. Statin Use and 25-Hydroxyvitamin D Blood Level Response to Vitamin D Treatment of Older Adults. J Am Geriatr Soc. 2017 Jun;65(6):1267-1273. doi: 10.1111/jgs.14784. Epub 2017 Feb 27.
3. Palamaner Subash Shantha G, Ramos J, Thomas-Hemak L et al. Association of vitamin D and incident statin induced myalgia--a retrospective cohort study. PLoS One. 2014 Feb 19;9(2):e88877. doi: 10.1371/journal.pone.0088877. eCollection 2014.
4. Taylor BA, Lorson L, White CM et al. Low vitamin D does not predict statin associated muscle symptoms but is associated with transient increases in muscle damage and pain. Atherosclerosis. 2017 Jan;256:100-104. doi: 10.1016/j.atherosclerosis.2016.11.011. Epub 2016 Nov 12.