Statins | A Pain in the Muscles?
Muscles on Taylor Lautner, Matthew McConaughey, and Hugh Jackman are hot. Muscles on ex-congressman Andrew Wiener and Senator Scott Brown are not. I used to power lift, until I hurt my rotator cuff at the tender age of 29. I still lift weights, but these days I do more aerobics and calisthenics. In fact, during an interview one of my future bosses read my curriculum vitae, looked at me in a skinny suit, and incredulously stated, “Your wrote you lift weights.” SPANK!
Is my statin breaking down muscle I have worked so hard at building up?
Statins are HMG CoA reductase inhibitor drugs that lower cholesterol. Simvastatin, pravastatin, Lipitor, and Crestor are well known statins. They are used both to prevent or treat coronary artery disease. They also can cause muscle problems.
In June 2011, the US Food and Drug Administration made the recommendation that patients not be started on simvastatin 80mg a day. Increasing simvastatin from 40 to 80mg only lowers cholesterol about 5%, so the risk of muscle injury from high dose simvastatin outweighs this small benefit. At the same time the FDA recommends continuing simvastatin 80mg if the patient has tolerated it for more than one year.
The billions of hours of statin commercials that plaque the airways have made patients rightfully wary of potential muscle problems that can rarely lead to death. Word of mouth on statin side effects is pretty powerful as well. “Doc, I don’t want to start a statin because my neighbor, my father, and my 2nd cousin once removed were all nearly crippled by those medicines!”
Though numerous studies on statins didn’t see any risk of myalgias (muscle soreness), myositis (muscle injury), or rhabdomyolysis (severe muscle injury that can lead to kidney damage) when compared to placebo, clinical practices suggest otherwise. So what is the truth?
As patient who takes a statin for high cholesterol (Damn this American diet. Instead I need to eat more fish and kimchi!), I can’t tell if my thighs ache because I exercise so much or is it a statin side-effect. In large clinical trials, 2-11% statin users complain of myalgias–but this compares to those taking a placebo.
Typical symptoms are muscle weakness and aches involving thighs and shoulders. It can be hard to get out of a chair or to lift things above the head. Less often, tendon pain and cramping occur with statin use.
“Myo” means muscle. “Myositis” means muscle breakdown, which releases an enzyme, creatinine phosphokinase (CK). CK levels at least ten times above normal are really significant because the chemicals released in muscle injury can damage the kidneys–called rhabdomyolysis–and be fatal. These bad events occur in less than 0.1% of statin users.
Rhabdomyolysis is very rare but can occur in patients simultaneously using other medicines that interact with the statin. Gemfibrozil (used to lower triglycerides), niacin (used to raise good cholesterol and lower triglycerides), some antifungals and antibiotics, cyclosporine and warfarin are a few drugs when combined with a statin can turn muscles into Salisbury steak.
Some folks with statin-induced muscle injury don’t have any symptoms. In a small study 10 of 14 test subjects without symptoms on a statin actually had muscle biopsies showing some level of muscle damage (unlike the one of eight control subjects).
We aren’t sure what causes the muscle damage. Perhaps it is that statins decrease coenzyme Q10, which is important in muscle cell energy production. It could be from an increase in plant sterols which are toxic to muscles.
Lowering cholesterol has been shown to greatly reduce heart disease, strokes, and atherosclerosis (clogged arteries). However, for some the statin wonder-drug might not be tolerated. In these people, they need to hold the myo–I mean mayo–in their meals and get some exercise.
(c) John Hong, MD, MS
