American Board of Internal Medicine (ABIM) Certification Practice Exam

Which hydrophilic statin is less likely to cause statin-induced myopathy?

1. Simvastatin

2. Rosuvastatin

3. Atorvastatin

4. Lovastatin

The correct answer is: Rosuvastatin

Rosuvastatin is considered a hydrophilic statin, which means it is more soluble in water compared to the lipophilic statins like simvastatin, atorvastatin, and lovastatin. The hydrophilic properties of rosuvastatin allow it to have a lower likelihood of penetrating muscle tissue, where most statin-induced myopathy occurs. Statin-induced myopathy can present as muscle pain, weakness, and in severe cases, rhabdomyolysis. The risk of developing these side effects is often associated with how much the statin can infiltrate the muscle cells. Since hydrophilic statins preferentially remain within the bloodstream and are less likely to concentrate in muscle tissue, they tend to have a better safety profile regarding muscle-related side effects. In contrast, lipophilic statins are more prone to enter muscle tissue and are, therefore, associated with a higher incidence of myopathy. This distinction makes rosuvastatin an ideal choice for patients who may be at heightened risk for muscle complications with other statin therapies. Consequently, the design and properties of rosuvastatin contribute to its reduced association with statin-induced myopathy compared to its lipophilic counterparts.