{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T16:24:43Z","timestamp":1791908683276,"version":"4.3.4"},"reference-count":27,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2014,8,21]],"date-time":"2014-08-21T00:00:00Z","timestamp":1408579200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100000265","name":"Medical Research Council","doi-asserted-by":"publisher","award":["MC_qA137929"],"award-info":[{"award-number":["MC_qA137929"]}],"id":[{"id":"10.13039\/501100000265","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Brit J Clinical Pharma"],"published-print":{"date-parts":[[2014,9]]},"abstract":"Aim<\/jats:title>The aim was to evaluate clinical risk factors associated with myotoxicity in statin users.<\/jats:p><\/jats:sec>Methods<\/jats:title>This was a cohort study of patients prescribed a statin in UK<\/jats:styled-content> primary care practices contributing to the Clinical Practice Research Datalink. Outcomes of interest were creatine phosphokinase (CPK<\/jats:styled-content>) concentrations and clinical records of rhabdomyolysis.<\/jats:p><\/jats:sec>Results<\/jats:title>The cohort comprised 641\u2009703 statin users. Simvastatin was most frequently prescribed (66.3%), followed by atorvastatin (24.4%). CPK<\/jats:styled-content> was measured in 127\u2009209 patients: 81.4% within normal range and 0.7% above <four times the upper limit of normal (ULN<\/jats:styled-content>). Rhabdomyolysis was recorded in 59 patients. Patients with concomitant prescribing of CYP3A4<\/jats:styled-content>\u2010interacting drugs had an increased odds ratio (OR<\/jats:styled-content>) of rhabdomyolysis compared with controls (OR<\/jats:styled-content> 3.71, 95% CI<\/jats:styled-content> 1.18, 11.61) and >four times ULN CPK<\/jats:styled-content> compared with normal CPK<\/jats:styled-content> (OR<\/jats:styled-content> 1.28, 95% CI<\/jats:styled-content> 1.01, 1.60). Rosuvastatin users had higher risk of >four times ULN CPK<\/jats:styled-content> (OR<\/jats:styled-content> 1.62, 95% CI<\/jats:styled-content> 1.22, 2.15) as did patients with larger daily doses of other statin types. A recent clinical record of myalgia was associated with an increased OR<\/jats:styled-content> of >four times ULN CPK<\/jats:styled-content> (OR<\/jats:styled-content> 1.73, 95% CI<\/jats:styled-content> 1.37, 2.18). In patients who were rechallenged to statins and had repeat CPK<\/jats:styled-content> measurements after >four times ULN CPK<\/jats:styled-content> abnormalities, 54.8% of the repeat CPK<\/jats:styled-content> values were within normal range, 32.1% between one to three times and 13.0% >four times ULN<\/jats:styled-content>.<\/jats:p><\/jats:sec>Conclusions<\/jats:title>The frequencies of substantive CPK<\/jats:styled-content> increases and rhabdomyolysis during statin treatment were low, with highest risks seen in those on large daily doses or interacting drugs and on rosuvastatin. CPK<\/jats:styled-content> measurements appeared to have been done in a haphazard manner and better guidance is needed.<\/jats:p><\/jats:sec>","DOI":"10.1111\/bcp.12367","type":"journal-article","created":{"date-parts":[[2014,3,6]],"date-time":"2014-03-06T11:23:35Z","timestamp":1394105015000},"page":"649-659","source":"Crossref","is-referenced-by-count":28,"title":["Predictors and outcomes of increases in creatine phosphokinase concentrations or rhabdomyolysis risk during statin treatment"],"prefix":"10.1111","volume":"78","author":[{"given":"Tjeerd P.","family":"van Staa","sequence":"first","affiliation":[{"name":"London School of Hygiene & Tropical Medicine London UK"},{"name":"Utrecht Institute for Pharmaceutical Sciences Utrecht University Utrecht The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel F.","family":"Carr","sequence":"additional","affiliation":[{"name":"Department of Molecular and Clinical Pharmacology Wolfson Centre for Personalised Medicine and MRC Centre for Drug Safety Science University of Liverpool Liverpool UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helen","family":"O'Meara","sequence":"additional","affiliation":[{"name":"Department of Molecular and Clinical Pharmacology Wolfson Centre for Personalised Medicine and MRC Centre for Drug Safety Science University of Liverpool Liverpool UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerry","family":"McCann","sequence":"additional","affiliation":[{"name":"Clinical Practice Research Datalink Medicines and Healthcare Products Regulatory Agency London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Munir","family":"Pirmohamed","sequence":"additional","affiliation":[{"name":"Department of Molecular and Clinical Pharmacology Wolfson Centre for Personalised Medicine and MRC Centre for Drug Safety Science University of Liverpool Liverpool UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2014,8,21]]},"reference":[{"issue":"1","key":"e_1_2_8_2_1","doi-asserted-by":"crossref","DOI":"10.1002\/14651858.CD009217.pub2","article-title":"Statins for the primary prevention of cardiovascular disease","author":"Taylor F","year":"2013","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1001\/archinternmed.2012.2145"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/MOL.0b013e32825a6773"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2003.12.037"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11883-007-0050-3"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clpt.2006.02.013"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1161\/10.1161\/01.ATV.0000194548.11901.a4"},{"key":"e_1_2_8_9_1","first-page":"23","article-title":"Drug\u2010induced myopathies. 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