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8 (!) arm RCT of supplements: SPORT

Bottom line: no supplement lowered LDL greater than PBO

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What about CoQ10?

Statins ⬇️CoQ10 but no clear dose response

Small RCT: CoQ10 improved perception of sxs in pts with prior statin intolerance

Party line? May work, may not. Only harm is $

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Clinical recs for statin intolerance?

💡Take away statin & wait & reassess
💡Try your own n of 1 with rechallenge

Intolerance despite this? See cards guidelines
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Check CK if ⬆️LFTs

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Quick points:

👉Ok to use statins in other neumomuscular disorders

👉Muscle bx for statin myopathy? Not needed. Esp don't do it if acute rhabdo

👉Check CK at statin start: No need

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Another n of 1 statin trial, STATINWISE

👉didn't detect difference in muscle sxs between statin and pbo

Good data to decide if ok to restart/rechallenge statins!

Rechallenge does not apply to those with HMG-COA reductase Ab ❗️

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SAMSON trial:
🔍nocebo effect (more sxs if you know you are on statin?)
🔍n of 1 trial (person serves as their own control)

👉empty bottle, low sx severity score
👉no sx difference btw statin & pbo; but this was lower than if empty bottle

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What do we understand about exercise, statins, and CK?

We don't understand enough.

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