Are statins the cause of your muscle pain? Study says unlikely

  • Statins are medications that lower cholesterol levels in the blood, protecting against heart attack and stroke.
  • Like all medications, sometimes they cause side effects. These treatments have received negative media coverage because of possible adverse effects, such as muscle pain.
  • However, a large study of nearly 155,000 people concludes that statin therapies do not cause muscle pain in more than 90% of those who experience these symptoms.

Statins are an effective medication to lower blood cholesterol levels and reduce the risk of major cardiovascular problems like heart attack and stroke. While the pills are usually well-tolerated, some people may experience side effects, such as muscle pain.

A recent study suggests that statins are not the cause of muscle pain in 9 out of 10 people who experience these symptoms while taking the medication.

Researchers from Oxford Population Health published their study in The Lancet and presented their findings at the European Society of Cardiology Congress.

The researchers analyzed data from about 155,000 individuals across 23 large-scale randomized clinical trials from the Cholesterol Treatment Trialists’ Collaboration. Each trial had a follow-up time of at least two years. A review of this kind, using data from multiple studies, is known as a meta-analysis.

Using this large dataset, the researchers assessed the effect of statins on the frequency of muscle-related symptoms in people with various conditions.

Previous observational studies reported that 7%–29% of people taking statin therapy experienced statin-associated muscle symptoms.

This new research, however, shows that statin therapy only produced a 7% relative increase in muscle pain or weakness compared to placebo. This finding suggests that only around one in 15 of the muscle-related reports by patients receiving statins are caused by the statin.

Dr. Christina Reith, Senior Clinical Research Fellow at Oxford Population Health and joint lead author of the study, explained the research to Medical News Today.

“Statin therapies are a key tool in helping to prevent avoidable disability and death. Our research shows that, for most people taking a statin, any muscle-related symptoms they experience will not in fact be due to the statin itself – and so the potential benefits of statin therapy are likely to outweigh the muscle pain risks,” Dr. Reith said.

“We hope that these results will help doctors and patients to make informed decisions about whether to start or remain on statin therapy and that information provided to doctors and patients will be reviewed in light of our study results.”

– Dr. Christina Reith

Investigating the cause of muscle pain

The study showed that muscle-related adverse effects, such as muscle pain or weakness, are common in adults, regardless of whether they take statins or not.

“In our study we found that muscle symptoms occurred in about a quarter of people whether they were taking statins or the matching dummy tablet (known as placebo),” Dr. Reith explained.

“What our research showed was that most of the time (over 90%), muscle symptoms experienced by people taking statin therapy are not actually due to the statin. However, if people do develop muscle symptoms due to statins, this is most likely to occur in the first year of treatment.”

Benefits of statin therapy outweigh risks

The researchers found that for every 1000 people taking statins, the treatment may cause 11 cases of muscle pain or weakness per year.

Therefore, the known benefits of statin therapy in preventing cardiovascular disease, including heart attacks and strokes, are likely to outweigh the slightly increased risk of muscle-related side effects.

Dr. Tharusha Gunawardena, a cardiologist, not involved in this research, agrees. “Acknowledging the media phenomenon of a clear negative association made between statins and muscle aches, this is an important meta-analysis to show that muscle aches in themselves are a relatively unlikely direct side effect due to statins when compared with a placebo,” Dr. Gunawardena said.

This is an important finding in challenging a more prevailing narrative that muscle aches are a common side effect and often a considerable barrier to patient confidence in an otherwise important and safe medication,” he explained.

Implications for treating patients

Dr. Reith, who noted that healthcare professionals should consider these findings when considering a patient’s treatment, told MNT that “if people develop muscle symptoms whilst taking statin therapy, the statin should not be assumed to be the cause. In fact, if someone develops muscle symptoms whilst on a statin, we now know that most of the time (>90%) the statin will not be the likely cause.”

“It is important to remember that statins only work to prevent cardiovascular diseases such as heart attacks or strokes of the type whereby a blood vessel in the brain becomes blocked whilst they are taken, and the longer the treatment continues, the more these benefits build,” Dr. Reith highlighted.

“Therefore if someone stops taking statins they may increase their risk of these serious conditions, which can result in death or long-term disability. It is therefore important that patients talk to their doctor before stopping statin therapy,” he added.

Clinical guidelines on statins

Dr. Reith continued: “As a result of our work on statins and muscle effects we would suggest that clinical guidelines for the management of muscle pain in patients taking a statin take into account our findings, as well as information on muscle symptoms provided in statin labeling and patient information leaflets.”

“This will help doctors and patients to weigh the substantial cardiovascular benefits against the much smaller muscle risks of statins in deciding whether to start or remain on statin therapy,” she said.

These results suggest that healthcare providers should consider other possible causes of muscle-related symptoms in patients receiving statin therapy.

“For patients who report mild muscle symptoms when taking a statin, our research findings suggest that it is most likely that the symptoms are not due to the statin, and so statin therapy should continue until other potential causes have been explored,” Reith said.

“If patients are experiencing severe or unusual muscle symptoms, a simple blood test (known as creatine kinase) can be done to make sure the patient does not have a more serious, but very rare, muscle condition known as myopathy or rhabdomyolysis.”

Dr. Gunawardena agreed:

“Biochemical evidence of a rise in creatinine kinase may be useful in identifying if there is indeed muscle inflammation. Furthermore, [there should be] consideration of the role of peripheral vascular disease as another cause.”

“It would be important to consider a wider perspective of the origins of muscle aches, prior to drawing a conclusion that it is statin related,” he said.

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