Analysis of vitamin D levels in patients with and without statin-associated myalgia — A systematic review and meta-analysis of 7 studies with 2420 patients


Marta Michalska-Kasiczak | Amirhossein Sahebkar | Dimitri P. Mikhailidis | Jacek Rysz | Paul Muntner | Peter P. Toth | Steven R. Jones | Manfredi Rizzo | G. Kees Hovingh | Michel Farnier | Patrick M. Moriarty | Vera A. Bittner | Gregory Y.H. Lip | Maciej Banach | Lipid and Blood Pressure Meta-analysis Collaboration (LBPMC) Group
First published: October 22, 2014 |



Vitamin D (vit D) deficiency may be associated with an increased risk of statin-related symptomatic myalgia in statin-treated patients. The aim of this meta-analysis was to substantiate the role of serum vitamin D levels in statin-associated myalgia.


The search included PUBMED, Cochrane Library, Scopus, and EMBASE from January 1, 1987 to April 1, 2014 to identify studies that investigated the impact of vit D levels in statin-treated subjects with and without myalgia. Two independent reviewers extracted data on study characteristics, methods and outcomes. Quantitative data synthesis was performed using a fixed-effect model.


The electronic search yielded 437 articles; of those 20 were scrutinized as full texts and 13 studies were considered unsuitable. The final analysis included 7 studies with 2420 statin-treated patients divided into subgroups of patients with (n = 666 [27.5%]) or without (n = 1754) myalgia. Plasma vit D concentrations in the symptomatic and asymptomatic subgroups were 28.4 ± 13.80 ng/mL and 34.86 ± 11.63 ng/mL, respectively. The combination of data from individual observational studies showed that vit D plasma concentrations were significantly lower in patients with statin-associated myalgia compared with patients not manifesting this side effect (weighted mean difference −9.41 ng/mL; 95% confidence interval: −10.17 to −8.64; p < 0.00001).


This meta-analysis provides evidence that low vit D levels are associated with myalgia in patients on statin therapy. Randomized controlled trials are necessary to establish whether vitamin D supplementation reduces the risk for statin-associated myalgia.

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The meta-analysis has been prepared within the Lipid and Blood Pressure Meta-analysis Collaboration (LBPMC) Group ( This meta-analysis was written independently; no company or institution supported it financially. No professional writer was involved in the preparation of this meta-analysis.
Some of the authors have given talks, attended conferences and participated in trials and advisory boards sponsored by various pharmaceutical companies.
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