{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T13:05:22Z","timestamp":1789391122974,"version":"build-2803163510"},"reference-count":103,"publisher":"MDPI AG","issue":"18","license":[{"start":{"date-parts":[[2026,9,13]],"date-time":"2026-09-13T00:00:00Z","timestamp":1789257600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Department of Medicine, Division of Endocrinology, Diabetes and Nutrition, University of Maryland, Baltimore"},{"DOI":"10.13039\/100000062","name":"National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health","doi-asserted-by":"publisher","award":["R01DK128898"],"award-info":[{"award-number":["R01DK128898"]}],"id":[{"id":"10.13039\/100000062","id-type":"DOI","asserted-by":"publisher"}]},{"award":["R01DK128898"],"award-info":[{"award-number":["R01DK128898"]}],"id":[{"id":"https:\/\/ror.org\/00adh9b73","id-type":"ROR","asserted-by":"publisher"}]},{"name":"National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health","award":["R21AR077782"],"award-info":[{"award-number":["R21AR077782"]}]},{"award":["R21AR077782"],"award-info":[{"award-number":["R21AR077782"]}],"id":[{"id":"https:\/\/ror.org\/006zn3t30","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Int. J. Mol. Sci.","IJMS"],"abstract":"<jats:p>Statins are widely prescribed lipid-lowering agents and remain central to the prevention of atherosclerotic cardiovascular disease. Although generally well tolerated, they have been associated with neuromuscular adverse events, including new-onset or worsening myasthenia gravis (MG). Current evidence supports a primarily temporal association between statin exposure and MG onset or exacerbation; this signal has emerged largely from case reports, pharmacovigilance analyses, and retrospective observational studies, while more recent population-based observational data strengthen the association. Statin-associated MG should be distinguished from other statin-related neuromuscular syndromes, particularly toxic myopathy and immune-mediated necrotizing myopathy. Beyond cholesterol-lowering, statins may influence neuromuscular junction function through multiple converging mechanisms, including perturbation of the mevalonate\u2013dolichol\u2013glycosylation pathway, isoprenoid-dependent immune dysregulation, altered lipid raft integrity and acetylcholine receptor clustering, and coenzyme Q10-linked mitochondrial vulnerability. In this review, we summarize the clinical evidence linking statins to MG, outline key differential diagnostic considerations, and propose an integrated glycosylation\u2013immune\u2013structural\u2013metabolic framework to guide future mechanistic studies and potential risk-stratified clinical management.<\/jats:p>","DOI":"10.3390\/ijms27188150","type":"journal-article","created":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T12:09:51Z","timestamp":1789387791000},"page":"8150","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Statins and Myasthenia Gravis: Clinical Implications and Pathogenesis"],"prefix":"10.3390","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5616-6443","authenticated-orcid":false,"given":"Xiao","family":"Tian","sequence":"first","affiliation":[{"name":"Division of Endocrinology, Diabetes and Nutrition, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-8007-8809","authenticated-orcid":false,"given":"Peixiang","family":"Zhang","sequence":"additional","affiliation":[{"name":"Division of Endocrinology, Diabetes and Nutrition, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,13]]},"reference":[{"key":"ref_1","first-page":"e1096","article-title":"Correction to: 2025 Heart Disease and Stroke Statistics: A Report of US and Global Data From the American Heart Association","volume":"151","author":"Martin","year":"2025","journal-title":"Circulation"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"983","DOI":"10.15585\/mmwr.mm6735a4","article-title":"Vital Signs: Prevalence of Key Cardiovascular Disease Risk Factors for Million Hearts 2022\u2014United States, 2011\u20132016","volume":"67","author":"Wall","year":"2018","journal-title":"MMWR. 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