Statins may lead to muscle pain and joint weakness

Taking statins makes you more likely to be diagnosed with muscle pain, joint diseases and injuries, researchers have warned.

They found a 20 per cent increased risk of muscle problems in those on the cholesterol-lowering drugs compared with those not taking them.

The US team says the risk may be relatively small but it is important because millions of older patients with heart conditions take statins and their use may eventually widen to include healthy younger people.

Statins are the most widely prescribed drugs in Britain. The number of patients taking them is estimated at 5million to 8million.

But there have been persistent complaints about side effects such as muscle pain and weakness.

The most serious adverse reaction is myopathy in about one in 1,000 users, resulting in muscle pain, tenderness and weakness. This condition can progress to rhabdomyolysis, a complete breakdown of muscle cells that can lead to kidney failure and death.

In some patients muscle weakness may persist even after stopping the drugs. And a British Heart Foundation survey found that one in three patients prescribed the drugs doesn’t take them, partly because of side effects.

The latest study investigated the scale of illnesses linked to statins, including muscle weakness, muscle cramps and tendon diseases.

Dr Ishak Mansi, of the Veterans Association North Texas Health Care System in Dallas, and colleagues used data from the US military health care system.


Patients were divided into two groups: 6,967 who used statins for at least 90 days in 2005, and 6,967 non-users, says a report published online by JAMA Internal Medicine.

Statin patients were almost 20 per cent more likely than non-users to have a diagnosis of a musculo-skeletal disease, a 13 per cent higher risk of a dislocation, strain or sprain, and slightly higher risk of muscle pain.

They were no more at risk of joint diseases such as osteoarthritis than non-users. The report said: ‘To our knowledge, this is the first study to show statin use is associated with an increased likelihood of diagnoses of musculoskeletal conditions, joint diseases and injuries.’

There have been growing calls for healthy over-50s to take statins, not just those at extra risk of a heart attack. But the researchers say any significant effect on general health, however small, should be carefully considered.

‘These findings are concerning because starting statin therapy at a young age for primary prevention of cardiovascular diseases has been widely advocated,’ they say.

Manufacturers’ warnings about side effects include muscle pain and weakness, memory loss, fatigue, sleep disturbances, sexual dysfunction and depression. There is also a higher risk of developing diabetes.

British experts said the study showed a very small impact of statins, increasing the risk of musculoskeletal disorders overall from 85 per cent in those not on statins to 87 per cent on a statin. Helen Williams of the Royal Pharmaceutical Society said she feared patients might stop taking the drugs.

She said: ‘In the UK we have around five million people taking statins to prevent heart attacks and strokes. If 1 per cent of these patients stop taking their statins due to concerns about muscle pains we will see at least 2,000 more heart attacks and strokes over the next ten years as a result, but avoid only 1,000 musculoskeletal problems.

‘Patients should be reassured that musculoskeletal disorders occur commonly but they are rarely due to taking statins.’

Dr Tim Chico, of the University of Sheffield/Sheffield Teaching Hospitals, said: ‘Statins save lives when used in the right type of patient, generally those at higher risk of stroke or heart attack because of other medical problems.

‘With statins the benefits are hidden; many people were going to have a heart attack today that was prevented by their statins, but they will never know. The side effects of statins are often all too obvious, and this biases many people against a potentially life-saving tablet.’

Statins should be given to all over 50s

Statins should be given to all over-50s, regardless of their health history, because they dramatically cut the risk of heart attacks and strokes in later life, one of the UK’s leading experts has said.

Currently statins are given only to high-risk patients, around eight million people, who have high cholesterol or have a risk of heart disease.

But there is ‘clear evidence’ that healthy people can also benefit based on their age alone, says Professor Sir Rory Collins.

He led the world’s largest study to investigate statins in the prevention of cardiovascular disease which proved that cutting levels of ‘bad’ LDL cholesterol in the blood saved lives.

The risk of having a major vascular event such as a heart attack is cut by one-fifth for each 1.0mmol/L (millimoles per litre) fall in LDL, whether in high or low risk patients.

But current guidelines on their use – and misguided safety fears about muscle pain and memory loss – are restricting the range of people who can take them, he said.

‘At 50 you should be considering it and whether you should be taking them at an earlier age is an open question’ he said.

‘If you start treatment earlier and continue for longer the benefits will be much greater, you’re not trying to unfur the arteries, you’re preventing them from furring in the first place’ he said.

Prof Collins, who was giving a keynote lecture at the European Cardiology Congress in Munich, said evidence from 130,000 patients taking statins in trials show they are safe.

Yet drug safety watchdogs here and in the US have insisted on flagging up relatively minor side effects which are putting patients off the drugs, he said.

Statins have been hailed as a “wonder drug”

These include memory loss, depression, sexual difficulties and depression, while recent research suggests cataracts and diabetes may be more common in patients taking statins.

Trial data shows only one significant side effect, myopathy or muscle pain, which affects one in 10,000 patients, said Prof Collins.

He said: ‘We need to look properly at the safety of statins. The reality is that these drugs are remarkably safe, but the problem is that high risk patients are getting the message that these drugs have side effects.’

Prof Collins, 57, went to his GP a fortnight ago to ask about taking statins despite a relatively low cholesterol level, and was dismayed to learn she could not get high risk patients to take them because of fears about side effects.

Research earlier this year co-ordinated by the Clinical Trial Service Unit Oxford University, where Prof Collins is co-director, reviewed findings from 27 statin trials involving 175,000 people, some of whom were at low risk of heart problems.

The drugs cut the risk of heart attacks, strokes and operations to unblock arteries by one third or more.

The benefits were gained no matter what level of cholesterol patients started out with. Healthier people who were given statins also had lower overall death rates than those who were given a placebo.

It concluded the positives greatly exceeded any side-effects from taking the drugs.

More than eight million adults are already taking statins, but it is estimated that routine use by the over 50s would lead to 10,000 fewer heart attacks and strokes a year, including 2,000 fewer deaths in the UK.

The small cost of the drugs – as low as £16 a year – would be outweighed by NHS savings due to the reduced number of heart attacks and strokes.

At present, statins are restricted to those with at least a 20 per cent risk of having a heart attack or stroke over the next five years.

But, said Prof Collins, trial data shows very low risk groups can benefit where individuals have just a five to 10 per cent chance of heart disease, and even lower.

He said there did not appear to be a threshold at which the drugs didn’t work and the longer they were taken, the greater the benefit.

‘We need to review the guidelines and the current thresholds should go,’ said Prof Collins, who claimed medical tests such as liver function were also unnecessary.

Professor Peter Weissberg, medical director of the British Heart Foundation, said: ‘The issue is where do you set the threshold between low, normal and high risk.

‘The current arbitrary threshold was decided by cost but now statins are off patent (and much cheaper) it may be appropriate to see if there are benefits for more people – the threshold is a bit too high,’ he added.