ABSTRACT
History A 48-year-old engineer presented to his family physician for a routine check-up examination at the insistence of his wife who was worried about his heavy smoking (about one pack of cigarettes per day for the past 10 years). He was drinking four or five beers per week and was taking no medications. He had no physical complaints, except for some dryness of his skin.The physical exam was unremarkable except for an elevated blood pressure (BP) of 160/105 mm Hg. His body mass index (BMI) was 24.5 kg/m2. He had no significant family history of cardiovascular disease (CVD).The laboratory values revealed a total cholesterol of 280 mg/dl, LDL-cholesterol 208 mg/dl, HDL-cholesterol 40 mg/dl, and Lp(a) 40 mg/dl. Otherwise the routine laboratory values, including (creatine kinase) CK, were unremarkable. An appointment with a dietician was scheduled for the coming week. During that visit his BP was found again to be elevated, so he was started on a diuretic and simvastatin 40 mg/day.Three weeks later he presented at his doctor’s office complaining of severe, diffuse, muscle aches. In a blood test that was performed the same day the CK values were found to be increased (780 U/l, normal < 174 U/l).The LDL-cholesterol level was down to 170 mg/dl. His physician diagnosed a statin-induced myopathy, discontinued his statin immediately, and referred the patient to our outpatient clinic for further management.
