People worry more than they should about the possibility of serious muscle problems when taking statins because these side effects are extremely rare, said research published this Thursday in the journal The Lancet Digital Health.
Heart disease is the leading cause of death worldwide, and statins can reduce LDL cholesterol levels by up to 60%, decreasing the risk of having a heart attack or stroke. However, despite more than 50 years of data showing that cholesterol-lowering medications are safe, many people are still reluctant to take statins for fear of side effects.
Less than half of the approximately 50 million people in the United States who could benefit from statins use them, and up to a third of people never fill their statin prescriptions. It is not uncommon for people to stop taking the drug shortly after it is prescribed: research has shown that around 40% of people prescribed a statin stop taking it within three months.
“There is a lot of concern in the general population about these medications because of rare side effects,” said Dr. Nishant Shah, a preventive cardiologist at Duke Health in Durham, North Carolina, who was not involved in the latest research.
In the new study, British researchers developed a tool that can help doctors predict their patients’ risk of statin side effects, including muscle disorders.
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Among these are the myopathya broad term that covers conditions that affect the muscles and cause pain, weakness and fatigue; the myalgiawhich refers to muscle pain; and the rhabdomyolysisa dangerous condition in which muscle tissue breaks down rapidly and toxins leak into the blood.
Rhabdomyolysis can be fatal.
The new study, which used data from medical records of almost 6 million adults in the United Kingdom, found that only about 0.04% of people had a greater than 10% 10-year risk of serious muscle disorders related to statins.
That figure is even lower than previous figures, including those in an American Heart Association (AHA) report, which put the rate of myopathy at less than 1% and the rate of rhabdomyolysis at less than 0.1%.
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“Even if it were multiplied by 10, it would still be a very small risk,” said Dr. Bart Duell, a professor of medicine at Oregon Health and Science University in Portland, who co-authored the AHA report but was not involved in the new research. The risk of muscle side effects “is really not a reason not to use statins,” he added.
In clinical trials, people taking a statin were slightly more likely to report mild muscle pain than those taking a placebo, but in most of those cases, the muscle pain had been caused by something other than the medication.
While patients should be aware of the possible side effects of any medication, experts noted that many they overestimate the risk of statins.
“In my 40 years of practice, I have never admitted a patient to the hospital for a statin-associated muscle disorder,” said Dr. Steve Nissen, academic director of the Heart, Vascular and Thoracic Institute at the Cleveland Clinic, who was not involved in the study. Nissen is a consultant for statin makers AstraZeneca, Bristol Myers Squibb, Novartis and Pfizer, but receives no financial compensation.
Misinformation feeds fear
Statins – including atorvastatin (Lipitor), rosuvastatin (Crestor), and simvastatin (Zocor), among others – are some of the most prescribed and most studied medications in the world.
“It’s not clear to us why the side effects of statins attract so much attention compared to other medications,” said study co-author Ting Cai, a researcher at the Nuffield Department of Health Sciences in Primary Care at the University of Oxford in the United Kingdom.
Duke Health’s Shah said the belief that statins are more dangerous than they really are is due to a combination of factors.
“There’s a lot of messages on social media about it, there’s medical misinformation on non-peer-reviewed websites, there’s just word-of-mouth concerns, anecdotal stories from family members who maybe have had problems,” Shah said. “All of that adds up to concern and then people communicate and communicate until that belief spreads widely.”
Duell said patients should weigh the risks and benefits of any medication.
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“For someone who has high cholesterol and perhaps a family history of heart disease, the very small risk of side effects is greatly dwarfed by the benefits of lowering cholesterol with medication,” he said.
He added that if people start taking a statin and have any concerns, You should tell your doctor.
“There is a big difference between being well before taking a statin and suffering a serious complication, so our goal is always to intervene before any serious damage occurs, such as muscle breakdown,” he said.
Doctors can always stop a patient’s statin to see if side effects, such as mild muscle pain, go away, or reduce the dose. Statins are not the only medications available to lower cholesterol.
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“The side effects of statins are talked about as if they were an inescapable fact, but there are a couple of important points: almost all side effects are dose related. It’s not always a yes or no answer; taking or even starting at a lower dose can minimize the risk,” Duell said.
Personalized risk with statins
The new tool was designed for doctors to use during consultations to better predict each patient’s risk of developing rare but serious muscle disorders if they take statins.
“Often people rely on population-wide numbers, or an anecdote about someone who had complications, but they don’t know what will happen to them based on their personalized information, age, lifestyle and other health conditions,” Cai said.
His team made sure to differentiate mild muscle symptoms, which are the most commonly reported, from myalgia and rhabdomyolysis.
“These more serious results are the ones that must be taken into account when considering taking statins,” he said.
This is by no means the only tool available to calculate the personalized risk associated with statins. The American College of Cardiology has a tool that allows doctors to assess a patient’s risk of developing side effects based on the dose and specific medication they are taking.
Some people do have a higher risk of side effects from statins, including those with kidney disease and those taking certain medications. Vitamin D deficiency can also cause muscle pain when taking statins, said Nissen of the Cleveland Clinic.
Duell said people need to be reassured about safety. “It is very unlikely let the horror stories people talk about happen,” he said.
