Table 3.
OR of increased CPK concentrations (compared with statin users with normal CPK concentrations) and of rhabdomyolysis (compared with statin users without rhabdomyolysis) stratified by type and dose of statin exposure
| Risk factor | One to two ULN* | Two to three times ULN* | Three to four times ULN* | >four times ULN* | Rhabdomyolysis† | Rhabdomyolysis or 10+x ULN† |
|---|---|---|---|---|---|---|
| Adjusted OR (95% CI)‡ | Adjusted OR (95% CI)‡ | Adjusted OR (95% CI)‡ | Adjusted OR (95% CI)‡ | Adjusted OR (95% CI)‡ | Adjusted OR (95% CI)‡ | |
| Type of statin | ||||||
| Simvastatin | Reference | Reference | Reference | Reference | Reference | Reference |
| Atorvastatin | 1.05 (1.01, 1.09) | 1.11 (1.02, 1.21) | 0.93 (0.79,1.10) | 1.03 (0.88, 1.20) | 1.18 (0.47, 3.01) | 1.31 (0.91–1.88) |
| Pravastatin | 0.94 (0.87, 1.02) | 1.12 (0.94, 1.34) | 1.05 (0.77, 1.44) | 0.99 (0.72, 1.36) | 3.28 (0.56, 19.27) | 1.19 (0.58–2.45) |
| Rosuvastatin | 1.22 (1.13, 1.32) | 1.49 (1.25, 1.76) | 1.16 (0.84, 1.62) | 1.62 (1.22, 2.15) | 2.92 (0.59, 14.47) | 2.90 (1.40–6.01) |
| Type and dose of statin | ||||||
| Simvastatin 10 mg | Reference | Reference | Reference | Reference | Reference | Reference |
| Atorvastatin 10 mg | 1.05 (0.98, 1.13) | 1.00 (0.85, 1.18) | 0.94 (0.68, 1.29) | 1.09 (0.79, 1.49) | 3.04 (0.39, 23.37) | 1.55 (0.70–3.42) |
| Rosuvastatin 5 mg | 1.34 (1.12, 1.61) | 1.65 (1.13, 2.41) | 2.00 (1.03, 3.91) | 2.07 (1.06, 4.05) | – | 3.72 (0.76–18.27) |
| Simvastatin 20 mg | 1.08 (1.02, 1.15) | 0.97 (0.84, 1.12) | 1.19 (0.90, 1.56) | 1.16 (0.88, 1.54) | 0.63 (0.14, 2.95) | 0.82 (0.39–1.70) |
| Atorvastatin 20 mg | 1.19 (1.10, 1.29) | 1.18 (0.98, 1.42) | 1.35 (0.96, 1.90) | 1.29 (0.90, 1.84) | 0.51 (0.04, 6.10) | 0.94 (0.38–2.32) |
| Rosuvastatin 10 mg | 1.21 (1.08, 1.35) | 1.41 (1.12, 1.79) | 1.37 (0.86, 2.17) | 1.76 (1.15, 2.70) | – | 1.87 (0.51–6.82) |
| Simvastatin 40 mg | 1.10 (1.03, 1.16) | 1.01 (0.88, 1.15) | 1.21 (0.93, 1.58) | 1.33 (1.02, 1.73) | 1.84 (0.46, 7.33) | 1.53 (0.77–3.05) |
| Atorvastatin 40 mg | 1.31 (1.20, 1.43) | 1.30 (1.06, 1.60) | 1.29 (0.87, 1.92) | 1.52 (1.04, 2.23) | 1.74 (0.25, 12.02) | 1.86 (0.80–4.33) |
| Rosuvastatin 20–40 mg | 1.82 (1.52, 2.18) | 1.52 (0.99, 2.33) | 0.71 (0.22, 2.80) | 2.95 (1.58, 5.51) | 6.37 (0.66, 61.48) | 7.64 (1.92–30.40) |
| Simvastatin 80 mg | 1.41 (1.17, 1.71) | 1.13 (0.71, 1.80) | 2.79 (1.53, 5.08) | 2.21 (1.13, 4.33) | 17.32 (0.46, 647.3) | 2.59 (0.69–9.68) |
| Atorvastatin 80 mg | 1.11 (0.96, 1.29) | 1.09 (0.78, 1.52) | 0.93 (0.48, 1.82) | 1.87 (1.13, 3.12) | 5.23 (0.21, 132.8) | 4.71 (1.51–14.69) |
Patients with increased CPK concentrations were compared with unmatched statin users with normal CPK concentrations.
Patients with rhabdomyolysis (or with >10 times ULN CPK concentrations) were compared with matched statin users without rhabdomyolysis who did not have a CPK measurement or a CPK concentration below >10 times ULN.
Adjusted for body mass index, smoking status, number of non-statin prescriptions in the previous 3 months, recent prescribing of antihypertensives, CYP3A4 interacting drugs, non-CYP3A4 interacting drugs, oral corticosteroids, history of atrial fibrillation, hypothyroidism, hyperthyroidism, chronic obstructive pulmonary disease or diabetes mellitus; in the comparisons with normal CPK, the analyses were also adjusted for age and gender.