Box 1.

Key points about SAMS for clinicians

What are SAMS? Muscle pain, weakness and aches, usually symmetrical and proximal, affecting the thighs, buttocks, calves and back muscles. Not normally associated with marked creatine kinase (CK) elevation. When do SAMS occur? Tend to occur early (within 4–6 weeks of starting a statin), after an increase in statin dose, or with initiation of an interacting drug. Who is at risk of SAMS? The very elderly (>80 years), notably female, or with low body mass index or of Asian descent, with a history of muscle disorders, or concurrent conditions (e.g. acute infection, impaired renal or hepatic function, diabetes, HIV) or concomitant interacting medications. How did the EAS Consensus Panel define SAMS? By the nature of muscle symptoms, and their temporal association with statin initiation, discontinuation, and response to repetitive statin re-challenge. What determines management of SAMS? The magnitude of CK elevation, and the patient’s global cardiovascular risk.