Dietary and nutrient influences on statin-associated muscle symptoms: mechanisms and insights

Statin-induced myopathy poses a significant challenge in cardiovascular pharmacotherapy, complicating hyperlipidemia management. While statins effectively reduce cholesterol via HMG-CoA reductase inhibition, the multifactorial nature of statin-associated muscle symptoms (SAMSs) underscores the role of dietary factors and nutrients. This narrative review, based on a comprehensive literature search of PubMed, Scopus, and Web of Science (2000–2024) with iterative searches and manual reference checks to ensure thoroughness, provides a critical synthesis of the interplay between diet, nutrients, and SAMSs, integrating mechanistic insights (e.g., mitochondrial dysfunction, oxidative stress) with clinical evidence. Unlike prior reviews, we explore underexplored nutrients, such as selenium and branched-chain amino acids, and dietary patterns like the Mediterranean diet, while critically evaluating conflicting findings on established nutrients (e.g., coenzyme Q10, vitamin D, omega-3 fatty acids). By identifying key research gaps, such as the need for personalized dietary interventions and standardized outcome measures, and proposing actionable clinical strategies, this review offers a novel framework to guide future research and enhance patient care. Our work facilitates targeted nutritional interventions to mitigate SAMSs, improve statin adherence, and optimize cardiovascular outcomes.