Paul S. Phillips, MD
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Phillips P.; Ezetimibe and Statin-Associated Myopathy. Ann Intern Med. 2004;141:649. doi: 10.7326/0003-4819-141-8-200410190-00021
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Published: Ann Intern Med. 2004;141(8):649.
TO THE EDITOR:
The letter by Fux and colleagues (1) suggesting an interaction between ezetimibe and statin-associated myopathy confirms our own findings. It is known that most lipid-lowering therapies, including statins, fibrates, and niacin, may cause muscle toxicity. The common feature of these therapies is that they reduce levels of triglycerides and free fatty acids. Hypertriglyceridemia is common among patients with reactions to lipid-lowering therapies (2), some of whom may have defects in fatty acid oxidation (3). Respiratory exchange ratios have been used to identify abnormalities in fatty acid oxidation (4). The fasting respiratory exchange ratio is increased in patients with statin muscle toxicity, suggesting defective fatty acid oxidation (5). Muscle disorders and abnormal excretion of urinary organic acids in patients with statin-induced muscle toxicity also suggest impaired oxidation of fatty acids (6). Normal asymptomatic controls demonstrate an increase in basal, fasting respiratory exchange ratio while taking statins, further supporting the sensitivity of this test in assessing changes in fatty acid oxidation induced by lipid-lowering therapies (7).
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