Rosuvastatin is the most appropriate treatment for this patient with hyperlipidemia. Hydrophilic statins, especially rosuvastatin but also pravastatin and fluvastatin, are less likely than lipophilic statins (such as atorvastatin, simvastatin, and lovastatin) to cause statin-induced myopathy and can be used at low doses in patients with previous statin-related myalgia, myopathy, or mild rhabdomyolysis. Hydrophilic statins also are much less likely than lipophilic statins to cause muscle weakness and elevated serum creatine kinase levels. Lipophilic statins should be avoided in patients with previous statin-related myopathy or rhabdomyolysis. Recently, an immune-mediated necrotizing form of statin myopathy that is associated with anti-HMGCR autoantibodies has been identified in some statin-exposed patients; this form continues to progress even after removal of the statin and may require immunosuppression as treatment. This patient, whose symptoms have resolved after discontinuation of the simvastatin, has no evidence of this type of statin myopathy.

Gemfibrozil is a fibric acid derivative that is typically used for the treatment of hypertriglyceridemia. If added to statin therapy, gemfibrozil raises the serum concentration of statins by twofold, which increases the risk of rhabdomyolysis. Cytochrome P3A4 inhibitors, such as antifungal agents, macrolides, immunophilin ligands, and tricyclic antidepressants, also can increase risk of statin-induced myopathy.

Although selenium supplementation does not treat hyperlipidemia, it has been suggested as a potential method of preventing statin-induced myopathy. Available evidence, however, does not allow a definitive conclusion to be drawn.