The association of serum 25-hydroxyvitamin D status and statin-associated musculoskeletal symptoms

Autor: Morioka, Travis Y
Rok vydání: 2012
Druh dokumentu: Thesis/Dissertation
Popis: Thesis (M.A.)--Boston University PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you.
Objectives: In this study, we investigated the relationship between serum vitamin D status and the prevalence of musculoskeletal pain among individuals on statin therapy. We hypothesized that lower serum vitamin D concentration would be associated with a higher odds of self-reported musculoskeletal pain among statin users. Background: HMG-CoA reductase inhibitors, or statins, are widely used lipid-lowering drugs that significantly reduce morbidity and mortality associated with heart disease. Statin use is associated with a higher prevalence of self-reported musculoskeletal pain in the general population. Non-blinded studies have shown improvement in statin-associated myalgia symptoms and increased tolerance to statin therapy after treatment of vitamin D deficiency. Methods: We performed secondary data analyses using the National Health and Nutrition Examination Survey (NHANES) 2001-2004. Employing SAS and SUDAAN, we carried out logistic regression to evaluate whether vitamin D deficiency modified the relationship between statin use and musculoskeletal pain. Based on a priori assumptions, we adjusted for the effects of demographics, selected disease states, and health habits in the logistic regression model. We also explored concentration-related trends of the effect of vitamin D on musculoskeletal pain. Results: Among 5941 participants age 40 years and older, the mean serum vitamin D concentration was 23.5 ng/mL [95% Confidence Interval (CI) 22.4, 24.2]. There was no significant difference in the mean serum vitamin D concentration between statin users (23.3 ng/mL, 95% CI 22.3, 24.3) and non-statin users (23.5 ng/mL, 95% CI 22.8, 24.2). Statin users had higher odds [adjusted odds ratio (aOR) 1.57, 95% CI 1.15, 2.13)] of self-reported musculoskeletal pain in any area (specifically including the lower extremities, lower back, upper extremities, and upper back) compared with non-users. Vitamin D deficiency was not a predictor of musculoskeletal pain (aOR 0.95, 95% CI 0.70, 1.28) in the overall sample. However, we found vitamin D deficiency to have a significant interaction with statin use for the outcome of musculoskeletal pain (p for interaction = 0.01). After stratifying the sample according to statin use, we found that compared to statin users with a vitamin D concentration of 15 ng/mL or higher, those using statins with vitamin D concentration less than 15 ng/mL demonstrated substantially higher odds of musculoskeletal pain (aOR 2.56, 95% CI 1.25, 5.25). Assessment of vitamin D as a continuous variable did not reveal a concentration-related trend between increasing vitamin D concentrations and musculoskeletal pain (p for trend = 0.4). Conclusions: After controlling for multiple confounders, our analyses showed that serum vitamin D concentration less than 15 ng/mL was associated with musculoskeletal pain among statin users. However, among those not using statins, no association between serum vitamin D levels and self-reported musculoskeletal pain was demonstrated. We showed that vitamin D deficiency modifies the relationship between statio use and musculoskeletal pain. Treating vitamin D deficiency has other proven benefits including, bone health and skeletal muscle function. Our data suggests it may be reasonable to identify and treat vitamin D deficiency in patients who report musculoskeletal pain, using statins.
Databáze: Networked Digital Library of Theses & Dissertations
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