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. 2023 Mar 22;12(6):2444. doi: 10.3390/jcm12062444

Table 2.

Endogenous and exogenous risk factors predisposing SAMS adopted from Gulizia et al. 2017 [20].

Endogenous Risk Factors Exogenous Risk Factor
Elderly Intensive physical activity
Female sex High intensity statin therapy
Asian ethnicity Alcohol abuse
Positive history of muscle and/or joint pain Drug abuse
Inflammatory or metabolic neuromuscular disease
  •   -

    Spinobulbar muscular atrophy

  •   -

    Alpha 1 4 glucosidase deficiency

  •   -

    Carnitine palmitoyl transferase II deficiency

  •   -

    Dermatomyositis

  •   -

    Myotonic dystrophy types I and II

  •   -

    Malignant hyperthermia

  •   -

    Mcardle’s disease

  •   -

    Myasthenia gravis

  •   -

    Recurrent myoglobinuria

  •   -

    Mitochondrial myopathy

  •   -

    Necrotizing myopathy

  •   -

    Inclusion body myositis

  •   -

    Peripheral neuropathy

  •   -

    Polymyositis

  •   -

    Amyotrophic lateral sclerosis

 Drug interactions
  •   -

    Nicotinic acid

  •   -

    Amiodarone

  •   -

    Azoles

  •   -

    Antipsychotic drugs

  •   -

    Immunosuppressive drugs (cyclosporine)

  •   -

    Fibrates (gemfibrozil)

  •   -

    Protease inhibitors

  •   -

    Macrolides

  •   -

    Nefazodone

  •   -

    Verapamil

  •   -

    Warfarin
Positive history of increased CK (especially if CK > 10 ULN) Grapefruit or blueberry juice consumption (>1 L/day)
Positive family history of myopathy Unregulated supplements (e.g., red yeast rice, pleurotus mushrooms, etc.).
Induced myopathy by statins or other hypolipidemic drugs Surgical procedures
Low body mass index
Severe kidney failure (III-IV stage KDOQI)
Acute or decompensated hepatopathy
Hypertension/heart failure (secondary to kidney disease)
Untreated or undertreated hypothyroidism
Diabetes mellitus
Acute infection
Biliary obstruction
Major trauma with increased metabolic demand
Vitamin D deficiency
Genetic polymorphisms
  •   -

    Cytochrome P isoenzymes

  •   -

    Lipin-1 mutations

  •   -

    ABC transporter polymorphism

  •   -

    RYR gene variant

  •   -

    SLCO1B1 gene variant

Abbreviations: ABC = ATP-binding cassette, CK = creatine kinase; KDOQI = kidney disease outcome quality initiative, RYR = ryanodine receptor, SAMS = statin-associated muscle symptoms, SLCO1B1 = solute carrier organic anion transporter family member 1B1, ULN = upper limits of normal.