Achy Muscles from Statins? 4 Possible Solutions to Discuss with Your Doctor

According to health data, a significant number of people over the age of 40 use statins to manage cholesterol and reduce the risk of cardiovascular events. Statins, known for their potential to prevent heart attacks and strokes, are widely prescribed for individuals with cardiovascular disease or its associated risk factors. 

Statins are a safe and effective medication for lowering LDL cholesterol and reducing the risk of cardiovascular disease. Statins are especially beneficial for people at high risk of cardiovascular disease.

Specifically, cholesterol-lowering statins are medications used to reduce low-density lipoprotein (LDL) cholesterol levels, also known as "bad" cholesterol. LDL cholesterol can build up in the arteries and form plaques, narrowing or blocking the arteries and increasing the risk of heart attack, stroke, and other cardiovascular diseases.

Statins are one of the most effective medications for lowering LDL cholesterol and reducing the risk of cardiovascular disease. Statins work by blocking an enzyme in the liver that is responsible for producing cholesterol.

Benefits of Using Statins

Statins have been shown to reduce the risk of cardiovascular disease by up to 40%. Statins can also help to prevent strokes, heart attacks, and other serious health problems.

These drugs are especially beneficial for people at high risk of cardiovascular disease, such as those with diabetes, high blood pressure, or a family history of heart disease. Statins can also benefit people who have already had a heart attack or stroke.

In the United States, an estimated 40 million people use statins. Globally, an estimated 200 million people use statins. Statins are safe and effective for most people, but they can cause side effects in some people, such as muscle pain, headache, and nausea. Statins can also interact with other medications, adding additional side effects.

Professor Nilesh Samani, Medical Director of the British Heart Foundation, says most people can take statins without any difficulty. 

Statins are life-saving drugs, and most people who take them don’t experience side effects. Those who do suffer muscle pain and weakness should always ask their doctor if a different statin or dose might solve the problem.

Statin Intolerance - Muscle Pain and Discomfort

Some people experience side effects that lead them to want to discontinue the medication, thereby forgoing its protective benefits. 

Statins can cause two main types of muscle and joint pain:

• Myalgia: Myalgia is a general term for muscle pain. It can be caused by a variety of factors, including statins. Statin-related myalgia is typically mild and goes away on its own. However, in some cases, it can be severe and debilitating.
• Myopathy: Myopathy is a more serious type of muscle pain that is caused by damage to the muscle fibers. Statin-related myopathy is rare, but it can be life-threatening.

Symptoms of Statin-Related Muscle and Joint Pain

The symptoms of statin-related muscle and joint pain can vary from person to person. Some people may experience mild muscle pain, while others may experience severe pain that makes walking or climbing stairs difficult.

The pain may be localized in one area of the body, such as the legs or back, or it may be generalized throughout the body. The pain may also be accompanied by other symptoms, such as stiffness, weakness, and fatigue.

Risk Factors for Statin-Related Muscle and Joint Pain

The risk of developing statin-related muscle and joint pain is higher in certain people, including:

• People who are taking high doses of statins
• People who are taking other medications that can interact with statins
• People who are older than 65
• People who have a history of kidney or liver disease
• People who have a history of muscle problems

Understanding Statin Intolerance

Statin intolerance refers to an individual's inability to manage even the smallest doses of two or more statins, primarily due to their negative effects on muscles, joints, or the liver. Often, within a month of beginning statin treatment, these individuals might experience pain or weakness in the major muscles of their arms, shoulders, thighs, or buttocks, symmetrically affecting both sides.

Cleveland Clinic cardiologist Leslie Cho, MD, Head of Preventive Cardiology and Rehabilitation, says not many people have true intolerance.

True statin intolerance — when a person cannot take a statin even once a week — is extremely rare.

Dr. Cho says that approximately 5 to 10% of individuals who start statins experience intolerance. This is more prevalent among the elderly, women, and those on stronger statin medications. The good news is that these side effects typically subside within a month after discontinuing the statin.

Why the Problem?

As per the study featured in JACC: Basic to Translational Science, statins have been found to trigger irregular and spontaneous releases of calcium from storage sites within muscle cells. Typically, systematic releases of calcium from these repositories enable muscle contractions. However, uncontrolled calcium leakage might harm the muscle cells, potentially resulting in muscle pain and fragility.

The study indicates that while many individuals' muscle cells can handle this calcium release, others might be more vulnerable owing to their genetic makeup or lifestyle factors. In these individuals, the calcium leak induced by statins could overburden the muscle cells, leading to pronounced muscle pain and weakness.

In addition, the study revealed that moderate exercise might deter the alterations resulting in calcium leaks. Thus, regular physical activity could potentially serve as an effective method for individuals on statins to prevent muscle-related symptoms.

If you believe statins aren't unsuitable, consider discussing the following alternatives with your physician.

1. Review Potential Interactions

Occasionally, certain foods or other medications can hinder the body's ability to expel statins efficiently, leading to elevated statin levels. Here are some typical substances to be cautious of:

• Excessive alcohol consumption.
• Calcium-channel blockers like diltiazem and verapamil.
• Antiarrhythmic medications such as amiodarone and digoxin.
• Antibiotics with names ending in -mycin.
• Antifungal medications with names ending in -azole.
• Cholesterol-lowering fenofibrates.

2. Consider an Alternative Statin

While most statins are lipophilic and can passively diffuse into the muscle, others are hydrophilic and need active transport. Lipophilic statins, such as atorvastatin (Lipitor®), simvastatin (Zocor®), and fluvastatin (Lescol®), tend to cause more muscle discomfort. On the other hand, hydrophilic statins like rosuvastatin (Crestor®) and pravastatin (Pravachol®) generally cause fewer muscle issues. If you haven't tried a hydrophilic variant, consider discussing the possibility with your doctor.

3. Opt for a Reduced Dosage

Even a minimal dosage of a statin can be beneficial. Consider starting with a lower dose of a hydrophilic statin once a week, such as 2.5 mg of rosuvastatin on Mondays. If well-tolerated, you can incrementally add another day or increase the dosage, always under medical supervision.

By introducing statins slowly, 70% of “statin intolerant” patients end up being able to take a statin: 60% of them can take it every day, and 10% can take it three times a week.

4. Explore Alternative Treatments

If you find that statins aren't suitable for you, discuss other available options with your doctor. One alternative is ezetimibe (Zetia®), which can reduce LDL cholesterol by approximately 15%. Another avenue is PCSK9 inhibitors, such as alirocumab (Praluent®) and evolocumab (Repatha®). These potent medications can significantly lower LDL cholesterol without inducing muscle discomfort.

However, there's a catch: PCSK9 inhibitors can be costly, and some individuals may face challenges getting their prescriptions approved due to the price. Consequently, statins remain the predominant recommendation for cholesterol reduction.

Dr. Cho provides a word of warning: speak with your doctor first before you stop taking a statin.

It can greatly increase your chance of having a heart attack.

Common Statins

Common cholesterol statin medications include:

• Atorvastatin (Lipitor)
• Fluvastatin (Lescol XL)
• Lovastatin (Mevacor)
• Pitavastatin (Livalo, Zypitamag)
• Pravastatin (Pravachol)
• Rosuvastatin (Crestor)
• Simvastatin (Zocor)

Aging and Cholesterol

Aging, for many, brings about various health challenges, and managing cholesterol levels remains a prominent concern. According to the Centers for Disease Control and Prevention (CDC), high cholesterol poses risks for heart disease and stroke, two leading causes of death in the U.S. As individuals age, their risk for elevated cholesterol levels grows, making the management of this condition crucial for ensuring a healthier senior life.

Cholesterol, a waxy substance found in the blood, is essential for building healthy cells. However, too much can lead to fatty deposits in the blood vessels, restricting blood flow and potentially causing complications. 

For older adults, unchecked high cholesterol increases the likelihood of requiring long-term care. Reduced mobility, potential heart-related ailments, and strokes can necessitate consistent caregiving, either at home or assisted living facilities. Such scenarios not only impact the individual's quality of life but can also pose a substantial financial and emotional burden on their families.

Statins have emerged as a reliable solution for many. They work by inhibiting a specific enzyme in the liver, which is crucial for cholesterol production. Consequently, the liver extracts more cholesterol from the bloodstream, reducing overall cholesterol levels. 

For seniors, integrating statins into their health regimen could mean reduced risks associated with high cholesterol, ensuring better cardiovascular health and reducing potential long-term care needs.