Regular exercise is considered essential for good health. The benefits include weight control, diabetes prevention, blood sugar management, blood lipid control, improved mood, better sleep and a reduced risk of dementia. Most health professionals would agree that anything that enhances exercise should be encouraged. But what about things that might discourage exercise? How do doctors feel about statin side effects that interfere with exercise? This reader would like an answer to his dilemma:
Q. A cardiologist started me on atorvastatin because my cholesterol was borderline. I am 70 years old, 6 feet tall, 151 lb and very active.
Within a few weeks I was experiencing intermittent muscle pain. I also had to force myself to exercise because I tired very quickly. My sex drive dropped through the floor.
After ten months, I noticed joint pain that quickly escalated. Soon hip pain threatened to keep me from walking, so in early December I had to stop the drug.
Recovery started quickly and now after six weeks, I am feeling good again. I have a home testing kit to help monitor my cholesterol. What do you recommend for controlling it without drugs?
A. Statins like atorvastatin (Lipitor), pitavastatin (Livalo), rosuvastatin (Crestor) and simvastatin (Zocor) have become the foundation for heart attack prevention. Some people, however, experience debilitating side effects like those you mention.
A study in JAMA Internal Medicine (June 9, 2014) points out that long-term use of statins “are associated with less physical activity for as long as statins are used.” The authors note that this may be due to muscle pain, fatigue and weakness.
Why Are Statin Side Effects So Controversial?
Many health professionals find it hard to believe statin side effects exist. An article in the European Journal of Preventive Cardiology (March, 2014) concluded that symptoms such as arthritis, muscle pain and weakness are not caused by statins. They based this conclusion on randomized controlled trials carried out by drug companies.
But other studies report something quite different. Rita Redberg, MD, MSc, is a cardiologist and professor of medicine at the University of California San Francisco School of Medicine. She is also Editor of JAMA Internal Medicine. Together with her colleague, Mitchell Katz, MD, she wrote an editorial (JAMA Internal Medicine, Nov. 15, 2016) titled:
Here is what they write about statin side effects:
“Although reported rates of adverse events in clinical trials are low, this does not reflect the experience of clinicians who see patients who are taking statins. For instance, the experience of an NPR reporter with a calculated 2.9% risk of heart disease over 10 years using the recommended American College of Cardiology/American Heart Association (ACC/AHA) risk calculator, but still prescribed a statin, and experiencing adverse effects from the medication, is typical of what many clinicians see in practice. She reported that ‘going for a walk was like slogging through mud’ until ‘I ditched the statin. The weakness evaporated. I could run again.'”
These physicians go on to compare benefits to risks and note:
“Using the current data, the decision aid shows that of 100 people who take a statin for 5 years, only 2 of 100 will avoid a myocardial infarction [heart attack], and 98 of the 100 will not experience any benefit. There will be no mortality benefit for any of the 100 people taking the medicine every day for 5 years. At the same time, 5 to 20 of the 100 will experience muscle aches, weakness, fatigue, cognitive dysfunction, and increased risk of diabetes.”
That comes straight from cardiologist Rita Redberg, not some statin skeptic with no understanding of statistics.
If you are at significant risk for heart disease or have had a heart attack or a stent placed in a coronary artery, then statins make sense. If you experience no statin side effects then these drugs may well be helpful. But if statin side effects make it hard to exercise and you are otherwise healthy, it may be time to quote Dr. Redberg’s editorial to the prescriber.
The Take Home Message:
Exercise is at least as important as cholesterol control in preventing heart attacks. There are a number of ways you can keep your cholesterol down and still stay active.
We are sending you our Guide to Cholesterol Control and Heart Health, with tips on anti-inflammatory foods and Laura Effel’s strategy for lowering her LDL cholesterol 44 points in five weeks without a statin.
Anyone who would like a copy, please send $3 in check or money order with a long (no. 10) stamped (70 cents), self-addressed envelope:
- Graedons’ People’s Pharmacy, No. C-8
- P. O. Box 52027
- Durham, NC 27717-2027.
It can also be downloaded for $2 from the website: www.peoplespharmacy.com.
What has been your experience with statins? Have you managed to avoid all side effects or did muscle pain or arthritis cause you problems? Share your story in the comment section below.