Rationale for investigating metformin as a protectant against statin-associated muscle symptoms

The mechanisms underlying statin-associated muscle symptoms (SAMS) are not understood. Mitochondrial dysfunction and atrogin-1 activation are among the leading possible explanations for SAMS. Interestingly, metformin can enhance mitochondrial function and may affect atrogin-1 expression. Therefore, we sought to perform a systematic search of the literature to explore the relationship among statins, metformin, and SAMS.