What a terrific response by dtoce.
Amnesia,
I am also a cardiologist, and have developed a number of cholesterol medications in my career—including having designed and run a statin intolerance study.
I agree very much with what dtoce said, and also happy to provide a few tips that you might consider also—please make sure to partner with your physician(s), since you should smartly question anything provided on a public we forum.
1) Partner with your doc, as you are. You can also see a cardiologist who specializes in “statin intolerance”—these do exist! Given triathlon is important for your quality of life, taking this extra measure is a reasonable choice.
2) It appears unclear whether you are having statin myalgia (only symptoms) or statin myopathy (with or without injury measured by significant increased in muscle enzymes (ie, CK)). The latter means taking some more deliberate steps. Measuring CK is not considered routine management of statin associated muscle symptoms unless severe, as you know, but I think you can make the argument this is a special case in extremely impactful activities for your quality of life. An empathic doctor should work with you on this.
3) There are some medical conditions that may predispose to statin myalgia/myopathy, which might be subclinical. For example, hypothyroidism and Vitamin D deficiency—these are very easy to check and low hanging fruit to address.
4) There are very effective ways of managing statin choice and administration schedule to improve your symptoms. For example, change to daily fluvastatin or pravasatin, which are associated with lower muscle symptoms. I have personally found switching to weekly (or 2-3 times weekly depending upon LDL-C goals) rosuvastatin works quite well, and can resolve symptoms in the majority of patients.
Good luck!
Edit.
Realizing how patronizing it might sound advising another doctor to “partner with your doc”—I didn’t mean for it to come across that way. As physicians we tend to be tempted self-diagnose and self-treat-I know I have been guilty of it!
Amnesia,
I am also a cardiologist, and have developed a number of cholesterol medications in my career—including having designed and run a statin intolerance study.
I agree very much with what dtoce said, and also happy to provide a few tips that you might consider also—please make sure to partner with your physician(s), since you should smartly question anything provided on a public we forum.
1) Partner with your doc, as you are. You can also see a cardiologist who specializes in “statin intolerance”—these do exist! Given triathlon is important for your quality of life, taking this extra measure is a reasonable choice.
2) It appears unclear whether you are having statin myalgia (only symptoms) or statin myopathy (with or without injury measured by significant increased in muscle enzymes (ie, CK)). The latter means taking some more deliberate steps. Measuring CK is not considered routine management of statin associated muscle symptoms unless severe, as you know, but I think you can make the argument this is a special case in extremely impactful activities for your quality of life. An empathic doctor should work with you on this.
3) There are some medical conditions that may predispose to statin myalgia/myopathy, which might be subclinical. For example, hypothyroidism and Vitamin D deficiency—these are very easy to check and low hanging fruit to address.
4) There are very effective ways of managing statin choice and administration schedule to improve your symptoms. For example, change to daily fluvastatin or pravasatin, which are associated with lower muscle symptoms. I have personally found switching to weekly (or 2-3 times weekly depending upon LDL-C goals) rosuvastatin works quite well, and can resolve symptoms in the majority of patients.
Good luck!
Edit.
Realizing how patronizing it might sound advising another doctor to “partner with your doc”—I didn’t mean for it to come across that way. As physicians we tend to be tempted self-diagnose and self-treat-I know I have been guilty of it!