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GH treatment reduces total ghrelin in Prader–Willi syndrome (PWS) and may confound ghrelin studies in young PWS children

The statins most commonly associated with myalgia (simvastatin and atorvastatin) inhibit CYP3A4, which displays 25-hydroxylase activity in vitro . 5 Therefore, vitamin D deficient states may lead to ‘preferential shunting’ of CYP3A4 for hydroxylation of vitamin D, reducing availability of CYP3A4 for statin metabolism, leading to statin-induced toxicity. Higher serum 25-OH D concentrations may be protective against statin-induced myalgia, as statin rechallenge was more likely to be successful in patients who achieved higher post-treatment level (> 80 nmol/l) in our series. In conclusion, patients with statin-induced myalgia should be screened for vitamin D insufficiency. Vitamin D repletion may resolve myalgic symptoms and allow statin rechallenge. Future studies are required to clarify further the relationship between vitamin D insufficiency and statin-induced myopathy.