Statins, muscle loss, pain and weakness: The cost of lower cholesterol?

Being that the majority of VIGOR Training members are middle-aged, and that statins are the second most common prescription for this age group, it’s likely that many members may deal with one of the most common side effects of statin use: muscle pain.

With this realization in mind, and the fact that many men keep such pain and discomfort to themselves, I felt it was appropriate to share some information on statin induced myopathy (SIM) and related statin side effects.

If you experience this side effect, or know someone who does, I hope this article empowers action, so that short-term discomfort doesn’t become long-term disability.

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Statin Use in the United States

According to the CDC, as of August, 2019, lipid-lowering drugs ranked second behind antidepressants for prescriptions in adults aged 40-59 in the United States. For adults aged 60-79, they were the most common prescription.

Just as there are risks along with benefits for a COVID vaccine, the benefits of statins don’t come without risks or side effects either.

Known statin side effects include:

Being that so many VIGOR Training members are at an age where statins are often prescribed, I’ll focus on statins’ impacts on muscle function here.

Statins and Muscle Myopathies: Pain, weakness, and muscle loss

Lipophilic statins, such as simvastatin, atorvastatin, lovastatin, and cerivastatin are more likely to cause SIM.

As many as 29% of statin users experience muscle pain or other muscle-related problems. Rhabdomyolysis, an extreme form of myopathy that causes massive muscle loss, affects about 1 in 100,000 statin users. Also, 2-3 out of 100,000 experience immune-mediated necrotizing myopathy, where one’s immune system breaks down its own muscle tissue.

In one study, where 10.5% of stain users experienced muscle pain, the pain was so severe that 38% couldn’t even perform moderate-intensity physical activity and 4% became immobile.

Interestingly, exercise seems to exacerbate statin-related muscular problems. 

Older adults who use statins tend to lose strength faster and fall more often.

Even if a statin-user doesn’t experience debilitating side effects, the statins may compromise muscle growth, or even cause muscle loss, which ultimately harms one’s health and quality-of-life.

Though statins are supposed to improve cardiovascular health, muscle aches, pains, and cramps often keep statin-users from exercising, which reduces or compromises their cardiovascular health. Up to 50% of statin users stop taking them during the first year because of muscle pain.

The most common symptoms of statin-related myopathies include cramps, stiffness, and decreased muscular power. Muscle pain can occur in both the upper and lower limbs. 

Some research suggests statins change the properties of fast-twitch muscle fibers, which is the muscle type that most affects strength, speed, and power.

Clinicians may describe such a patient as having “statin intolerance.” Unlike lactose intolerance, which may cause diarrhea or excessive gas, statin intolerance can lead to serious muscle-related complications.

What causes statin induced myopathy?

Though doctors prescribe statins to achieve lower cholesterol levels in patients, statins do not lower cholesterol levels. They inhibit cholesterol production, which then affects many physiological needs and processes downstream of that inhibition.

I stress that point because few people understand how they work, and what negative impact they may have in comparison to their potential benefit. Fiber lowers cholesterol by removing existing cholesterol. Statins interrupt the production process. That’s a big difference, and explains why their use may lead to issues like muscle myopathies.

As one paper put it, 

statins represent the first line therapy in the prevention and treatment of metabolic syndrome.

Camerino GM, et al.

Think about that statement for a moment. Statins represent the first line therapy. Not a high-protein diet, strength training, improved sleep, or supplements, all of which can dramatically improve lipid and blood sugar levels, blood pressure, and body weight. Moving on…

Statin-related muscle pain may be caused by

  • decreased Coenzyme Q10 levels
  • increased rates of cell apoptosis (cell death)
  • reduction in mitochondria (the powerhouses of the cells)
  • dysfunction of glucose utilization
  • increased muscle breakdown, as evidenced by increased creatine kinase levels
  • reduction in other antioxidants besides CoQ10, which increases levels of free radicals

There’s still much debate about the cause of statin-related muscle pain. The actual cause might be all of the above, or some of the above depending on the individual.

What can you do to prevent muscle pain from statins?

Statins lower CoQ10, which may play a role in muscle pain and weakness. Supplementation with Coenzyme Q10 has been shown in some studies to reduce occurrence of SIM.

Vitamin D deficiency can also cause muscle pain and weakness, and the majority of Americans are low in vitamin D. Though a good doctor will check vitamin D levels as part of a routine check-up, and recommend enough vitamin D to reach optimal levels, if your doctor didn’t do that, demand that he or she does.

Low thyroid may also contribute to muscle weakness and pain. It also may cause elevated cholesterol, so once again, demand that your doctor order a complete thyroid panel, including thyroid peroxidase, T3, T4, and thyroid stimulating hormone (TSH). If your doctor won’t do that, find another doctor or order your own thyroid panel.

Assuming you’ve dealt with the above options, your doctor may also adjust your statin dose or try another therapy.

What are alternatives to statin therapy?

In the end, statins are designed to reduce levels of cholesterol and inflammation in your body, and reduce the risk of a cardiovascular event.

While some people with familial hypercholesterolemia may have extremely high LDL cholesterol, regardless of their diet and lifestyle choices, most people can significantly reduce their risk of heart disease through diet and lifestyle.

Hopefully, you have a doctor like I do, who helps you do everything possible through nutrition, exercise, and nutritional supplements before resorting to pharmaceuticals.

If so, he or she will likely encourage you to:

In addition, your doctor might have you start using heart health-supporting supplements like nattokinase, bergamot, or hydroxytyrosol.

For some people, even if they do everything right with their diet and lifestyle, they’ll still need to use a statin. But if the right choices allow them to use a lower dose, it might minimize the risk of this and other side effects.

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