Q: I started a cholesterol-lowering statin drug a few months ago, and now it seems like my muscles are always sore. How can I know if it’s the statin, the normal aches of aging or something else?
A: Statin drugs work by inhibiting cholesterol production in the liver as well as by removing the cholesterol from waxy deposits in our arteries called plaques. But about 1 in 10 people find the side effects to be so intolerable that they can’t continue taking statins at the recommended dose.
Some people may experience muscle aches, pain, weakness or cramps. The risk of these side effects is higher among female, older, obese, Asian and Black patients. Side effects also are more common among patients with kidney and liver disease.
Statins are lifesaving drugs, and some doctors are hesitant to blame the statin when a patient reports muscle aches. A key question to discuss with your doctor is how long you were taking a statin before the muscle pain started. This can help you determine whether the aches likely are a side effect of the drugs or related to another issue.
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Muscle symptoms tend to appear within 12 weeks of starting a new statin or increasing the dose. An analysis published in the Lancet in 2022 found that in the initial months of taking a statin, about 1 in 15 muscle symptoms could be attributed to the medication. While that may not be a huge portion of people, it’s still significant.
However, after one year of treatment, this difference vanished: Muscle symptoms were no different between people taking statins and people taking a placebo.
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What this tells us is that more than 90 percent of all muscle symptoms reported by participants on statins were not actually due to the statins. Instead, their symptoms were likely related to other conditions occurring around the same time — things like infections or autoimmune conditions, vitamin D deficiency, or low thyroid hormone. Also, many people are instructed to start exercising more as part of a healthy lifestyle around the same time as starting a statin, but as we age, our muscles are more prone to aching with exercise than in the past.
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Let me emphasize: The findings don’t mean that your muscle symptoms are imagined. They are still very real, and no doctor should brush off what you’re experiencing. If the statin is not the likely culprit, it’s important to work together to investigate other causes.
The impact of statins on our muscles
The most common muscle side effects of statins are pains and aches that aren’t likely to be injurious to your organs but still are extremely unpleasant. A severe muscle injury called myonecrosis, which is when the muscle fibers start to break down, happens to less than 1 in 1,000 patients. In very rare cases, a severe form of myonecrosis, known as rhabdomyolysis, may occur, leading to kidney damage. A study in JAMA found this happens in about 1 in 23,000 people being treated with a statin.
Your muscle symptoms are less likely to be related to your statin if they persist several months after stopping the medication — or, conversely, if they showed up immediately, within a day or so, after initiation. Statins are also less likely to be the problem if the aches started out of the blue after you had been on the medication for several months or years.
What can I do if I think statins are causing muscle pain?
It’s safe to continue your regular activities even when you experience muscle symptoms on statins — including moderate-intensity exercise. If your symptoms are severe, talk to your physician about testing for those rarer forms of muscle injury.
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Otherwise, you’ve got a few options to discuss with your provider.
Take a short statin break and restart. A study published last year in PLoS One found that about two-thirds of patients who thought their statin was causing them muscle aches were later able to tolerate their statin when they restarted one after a few weeks of taking a break.
Try a lower dose. The 2022 meta-analysis found that higher doses were associated with increased risk of experiencing muscle symptoms.
Switch to a different statin. Certain statins such as fluvastatin are less commonly associated with muscle issues — potentially because of how they are metabolized by the body.
Explore other medication options. People who take statins such as simvastatin or atorvastatin may be at higher risk of muscle symptoms if they’re taking certain antifungal or antiviral medications, heart medications such as diltiazem or amiodarone, colchicine and fibrates. Review your medication list with your provider to see whether there might be an interaction.
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Certainly, if none of these approaches are helpful or feasible, talk to your provider about statin alternatives, such as bempedoic acid.
What I want my patients to know
Statin medications were first approved by the Food and Drug Administration in 1987 and have dramatically changed how we treat cardiovascular disease, the leading cause of death in the United States. These drugs are lifesaving, but only 35 percent of people who would benefit from a statin are actually taking them.
Statins are not just recommended for people who have had heart attacks or strokes. Many people with high cholesterol, diabetes or high blood pressure can reduce the odds of having a bad outcome by starting one (and, of course, by adopting other good health measures such as quitting smoking and eating a Mediterranean diet). The U.S. Preventive Services Task Force recommends statins for adults ages 40 to 75 with one or more risk factors for cardiovascular disease.
Your doctor can do some simple calculations, based on your recent cholesterol levels and other information, to estimate your risk of heart attack over the next 10 years — and see how taking a statin might lower it.
