A Case Study on Statin Intolerance | Patient Case Quiz

A 75-year-old woman with longstanding hypertension presented with severe abdominal pain and new-onset atrial fibrillation and was hospitalized. Her medication at home included diltiazem 240 mg daily and omeprazole 40 mg daily for what was thought to be acid reflux. Her physical exam on admission revealed a blood pressure (BP) of 135/85 mm Hg, and heart rate (HR) of 52 beats/min and irregular. Her body mass index was 22 kg/m2. Her physical exam was also notable for epigastric tenderness, and abnormal lab values included hemoglobin (Hb) of 10 gms and a lipid profile as follows: total cholesterol (TC) = 305 mg/dl, triglycerides (TG) = 250 mg/dl, high-density lipoprotein (HDL-C) = 35 mg/dl, low-density lipoprotein (LDL-C) = 220 mg/dl.

She converted to sinus rhythm when placed on IV amiodarone. She underwent an esophagogastroduodenoscopy, which demonstrated a duodenal ulcer which was positive for Helicobacter pylori.

The patient requested that her discharge medications be chosen from her insurance company's drug formulary and included diltiazem 180 mg daily, amiodarone 200 mg daily, simvastatin 40 mg daily, and Flagyl 500 mg daily. Because of her anemia and peptic ulcer, anticoagulation was withheld.

Three weeks later, the patient presents to the emergency department with severe muscle pain and weakness, especially in her arms and thighs, and "rusty-colored" urine. Her BP is 98/60 mm Hg, and her HR is 52 beats/min. She appears acutely ill, although afebrile. Her labs now reveal the following: Hb = 10.9 gms, white blood count = 12,100, TC = 198 mg/dl, TG = 200 mg/dl, HDL-C = 32 mg/dl and LDL-C = 154 mg/dl, troponin 0.01, creatine kinase = 12,000; urine is positive for myoglobin.

Which of the following statements is TRUE?

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