Advertisement

Tendon Rupture Associated With Simvastatin/Ezetimibe Therapy

      A case of spontaneous biceps tendon rupture in a physician during therapy with the combination of simvastatin and ezetimibe (Vytorin) is reported. Rechallenge produced tendinopathy in the contralateral biceps tendon that abated with drug discontinuation. Tendon rupture generally occurs in injured tendons. Physiological repair of an injured tendon requires degradation and remodeling of the extracellular matrix through matrix metalloproteinases (MMPs). Statins are known to inhibit MMPs. It was hypothesized that statins may increase the risk of tendon rupture by altering MMP activity. In conclusion, statins may increase the risk of tendon rupture by altering MMP activity.
      To read this article in full you will need to make a payment

      References

        • Thompson P.D.
        • Clarkson P.
        • Karas R.H.
        Statin-associated myopathy.
        JAMA. 2003; 289: 1681-1690
        • Chazerain P.
        • Hayem G.
        • Hamza S.
        • Best C.
        • Ziza J.M.
        Four cases of tendinopathy in patients on statin therapy.
        Joint Bone Spine. 2001; 68: 430-433
        • Sharma P.
        • Maffulli N.
        Biology of tendon injury: healing, modeling and remodeling.
        J Musculoskeletal Neuronal Interact. 2006; 6: 181-190
        • Riley G.
        Chronic tendon pathology: molecular basis and therapeutic implications.
        Expert Rev Mol Med. 2005; 7: 1-25
      1. Matrisian LM. Metalloproteinases and their inhibitors in matrix remodeling. Trends Genet 1990l;6:121–125.

        • Riley G.P.
        • Curry V.
        • DeGroot J.
        • van E.B.
        • Verzijl N.
        • Hazleman B.L.
        • Bank R.A.
        Matrix metalloproteinase activities and their relationship with collagen remodelling in tendon pathology.
        Matrix Biol. 2002; 21: 185-195
        • Ritty T.M.
        • Herzog J.
        Tendon cells produce gelatinases in response to type I collagen attachment.
        J Orthop Res. 2003; 21: 442-450
        • Dollery C.M.
        • McEwan J.R.
        • Henney A.M.
        Matrix metalloproteinases and cardiovascular disease.
        Circ Res. 1995; 77: 863-868
        • Schonbeck U.
        • Libby P.
        Inflammation, immunity, and HMG-CoA reductase inhibitors: statins as antiinflammatory agents?.
        Circulation. 2004; 109: SII18-SII26
        • Turner N.A.
        • O’Regan D.J.
        • Ball S.G.
        • Porter K.E.
        Simvastatin inhibits MMP-9 secretion from human saphenous vein smooth muscle cells by inhibiting the RhoA/ROCK pathway and reducing MMP-9 mRNA levels.
        FASEB J. 2005; 19: 804-806
        • Birkedal-Hansen H.
        • Moore W.G.
        • Bodden M.K.
        • Windsor L.J.
        • Birkedal-Hansen B.
        • DeCarlo A.
        • Engler J.A.
        Matrix metalloproteinases: a review.
        Crit Rev Oral Biol Med. 1993; 4: 197-250