Tailoring strategies for dyslipidemia management and atherosclerotic cardiovascular disease prevention in muscular dystrophy patients.

OBJECTIVES

Patients with muscular dystrophies are at increased cardiometabolic risk due to reduced mobility, increased adiposity, glucose intolerance, and dyslipidemia. While statins remain the cornerstone of cardiovascular disease prevention in the general population, their use in muscular dystrophies is complicated by the presence of underlying muscle symptoms, which can be difficult to distinguish from statin-associated myopathy. This overlap contributes to heightened concerns about statin tolerance and may impair long-term adherence. The emergence of nonstatin lipid-lowering therapies presents an important opportunity to revisit the conventional "statin-first" approach. Therefore, we sought to highlight the under-recognized issue of atherosclerotic cardiovascular disease (ASCVD) prevention in patients with muscular dystrophy, and explore alternative lipid-lowering strategies beyond statins, given the unique challenges in this population.

METHODS

We conducted a comprehensive review of the existing literature on dyslipidemia and ASCVD risk in muscular dystrophies, evaluated current management guidelines, and shared our institutional experience by presenting the largest known case series of patients with muscular dystrophies treated with nonstatin lipid-lowering therapies.

RESULTS

Statin use in muscular dystrophy is complicated by the difficulty in distinguishing baseline muscle symptoms from statin-associated myopathy, leading to concerns about tolerance and adherence. Our case series demonstrates that nonstatin therapies are a viable and well-tolerated alternative in this population.

CONCLUSIONS

There is a critical need to expand the focus of cardiovascular care in muscular dystrophy to include ASCVD prevention. Nonstatin therapies represent a promising and practical option for managing dyslipidemia in patients with muscular dystrophy. Tailored approaches are needed to balance cardiovascular risk reduction with the unique neuromuscular challenges in this population.