DO STATINS CAUSE MUSCLE PAIN AND WEAKNESS?

It’s statins again! 

This time it has to do with muscle pain and weakness patients attribute to statin therapy. A study from the University of Oxford in the United Kingdom showed that greater than 90% of all reports of muscle symptoms which were ascribed to statin therapy were NOT DUE TO THE STATIN. That’s a very bold assertion and means that the overwhelming majority of aches and pains people attribute to their statin drug are caused by something other than the drug.

How do they know that? 

The design of the study and methods of administration of the drug were structured in such a way that participants in the study had no idea if they were or were not taking the drug. The terms used are “randomized” and “double-blind.” That means patients in the drug and placebo groups didn’t know what they were taking during the two-plus years. And also, those who had taken placebo at first, later took a statin and vice versa; statin-takers took placebo. That made it easier for investigators to determine if the statin drug was the cause of the pain.

During the first year of the study, only 7% of patients reported muscle pain or weakness. It was determined through further analysis that only one in 15 of these reports of pain was actually due to the statin. That means a lot of the muscle complaints occurred while the patient was taking placebo and not the statin.

After year one, there was no increase in reports of muscle symptoms. In other words, if patients had muscle symptoms, the majority of them occurred in the first year of administration, and very few new complaints were reported thereafter. In those patients whose symptoms could definitely be attributed to a statin, the majority were taking “more intensive statin regimens (40-80 mg atorvastatin or 20-40 mg rosuvastatin). [Lipitor, Crestor]

Dr. G’s Opinion: If you’re taking a statin and have muscle pain or weakness, this study says there’s a 90% chance the pain is not drug-related. They recommend treating it symptomatically with acetaminophen or ibuprofen and heat (hot bath/shower or heating pad). If the pain worsens or the muscles are tender to the touch, a blood test for abnormal muscle inflammation should be done. The test called creatine phosphokinase (CPK) measures an enzyme released by inflamed or damaged muscle cells and suggests the muscles are truly inflamed. If the CPK is elevated, the statin should be discontinued until the symptoms cease. 

During my practice years I prescribed statins with little hesitation. A lot of patients complained of aches and pains they attributed to the drug. This study tells me what I suspected; the majority of muscle symptoms attributed to statins is much less than one might suppose. I also ordered a lot of CPK blood tests to decide if the statin should be discontinued. CPK’s were rarely abnormal, and the statin was rarely discontinued. Having the data presented in this article reassures me about the decisions I made.

References: AAFP News: “For more than 90% of patients on statins experiencing muscle pain, the statin is not the cause of the pain, researchers conclude” AAFP Fam Med Today 2022 August 30.

Cholesterol Treatment Trialists’ Collaboration “Effect of statin therapy on muscle symptoms: an individual participant data meta-analysis of large-scale, randomized, double-blind trials” The Lancet.com 2022 August 29 https://doi.org/10.1016/50140-6736(22)01545-8