How important is exercise for overall health? Researchers report that exercise reduces blood pressure, cholesterol, heart rate, body fat and depression (British Journal of Sports Medicine, June, 2015). Randomized controlled trials have demonstrated that exercise produces “favorable findings in arthritis, cancer, diabetes, heart disease, and respiratory illness, among other chronic conditions” (BMJ, online, Oct. 1, 2013). These researchers found that exercise was at least as good as drugs for prolonging life. That’s why it is shocking to learn that statin side effects may make it harder to exercise.
Statins Are the Leading Heart Drugs:
The last time we checked, 93,000,000 prescriptions were dispensed annually for atorvastatin (Lipitor) . There were over 66 million Simvastatin (Zocor) bottles dispensed. Add in over 20 million rosuvastatin (Crestor) prescriptions and you are over 180 million bottles of the best selling statins. That does not include other statin-containing drugs.
If the average bottle contains 30 tablets or capsules that would be 5,400,000,000 pills. Many insurance companies are now encouraging 90 pills per bottle to cut down on costs, so the actual number of statin pills taken annually by Americans could easily exceed six billion! Can you wrap your mind around that many pills?
Do Statin Side Effects Exist?
Clearly, statin-type cholesterol-lowering drugs are the mainstay of heart disease prevention. For decades, some patients have been complaining about statin side effects. Many cardiologists, however, dismiss the idea that these medications commonly cause side effects.
That’s largely because the randomized controlled trials sponsored by drug companies reported very few, if any, adverse reactions from statins. One study published in the European Journal of Preventive Cardiology (April, 2014) analyzed 14 such trials and concluded:
“Only a small minority of symptoms reported on statins are genuinely due to the statins: almost all would occur just as frequently on placebo. Only development of new-onset diabetes mellitus was significantly higher on statins than placebo; nevertheless only 1 in 5 of new cases were actually caused by statins.”
What Do Patients Say About Statin Side Effects?
The most frequent complaint that we hear from patients is that statins trigger muscle pain and make it harder to exercise. Though many doctors are skeptical, we have received numerous reports like this one:
“I took statins for about ten years. During that time I noticed soreness in my hips and weakness in my leg muscles.”
“I stopped taking the medicine for 45 days. Most of my pain went away and my strength came back. I was told that I might have a stroke if I was not on a statin, so I decided to try the drug again. Now I can’t get out of a chair without using my arms. I’m 56 years old and have always been very strong.”
Another reader wrote:
“As a pharmacist I should have picked up on my muscle weakness while taking statins. For some reason I didn’t make the connection until I started having trouble climbing stairs. I was quite unstable.
“I finally brought this problem to my cardiologist’s attention, but he switched me to another statin that was just as bad. Finally I was switched to Crestor, which proved to be the worst.
“I had to tell the doctor that I was all done with statins. He wasn’t happy. During this time, he never even did a blood test. It took me about a year off statins to get back to normal. I have heard of others who never regained their muscle strength.”
Alice in Indiana got fed up:
“I would rather have high cholesterol than crippling pain which had gotten so bad that I could hardly walk.”
Martha in Abingdon, VA:
“I am a 79-year-old woman with no heart problems. I was started on simvastatin about 8 years ago. Lately my legs don’t seem to have any strength and I have developed plantar fasciitis. Stairs are quite difficult and I seem to be out of breath with little effort.
“Because of several moves in the past 15 yrs I have had three different doctors who only want to prescribe statins as an automatic answer because of my age. I told my doctor I now have that after doing research on statins, I am stopping them. He didn’t like it but said, ‘well, since you don’t have a heart risk we can see how you do.’
“It has been 6 months and my foot pain subsided after 3 weeks. I don’t wheeze as much but I think I have a long way before I can regain the strength in my legs. One of these days I think you’ll hear (after so many are harmed) the truth about these ‘medicines.'”
Deloris wrote:
“Whether it’s muscle pain or diabetes, the powers that be in health care claim that statin side effects are reversible. However, I quit simvastatin more than five years ago, and some of my side effects (primarily muscle pain and weakness) have steadily worsened.
“An electromyelogram and muscle biopsy showed that I have been irreversibly affected with denervation atrophy and peripheral neuropathy. I was also diagnosed with rheumatoid arthritis in the mean time. Doctors merely tell me that I’m out of shape, but I’ve become exercise intolerant because of the persistent pain that gets worse after any physical activity. They will not blame the statin.”
Some Doctors Are Questioning Conventional Wisdom:
Many doctors question whether such complaints of muscle pain and weakness could be caused by statins. As described above, drug company-sponsored clinical trials often reported no such adverse reactions.
An editorial by cardiologist Rita Redberg, MD, MSc, and Mitchell Katz, MD, in JAMA Internal Medicine (Jan., 2017) noted:
“Many of the trials did not ask about commonly reported statin effects, such as muscle pains and weakness, and only recorded myopathy, for which an increase in creatine kinase levels was required. Because most muscle problems do not involve an increase in creatine kinase levels, this leads to a significant underestimate of muscle problems. Other studies have estimated that closer to 20% of statin users have muscle problems.”
In other words, the people who designed these clinical trials were looking for very serious muscle breakdown. It was verified by elevations in the enzyme creatine kinase. If a patient “only” complained of muscle pain, soreness or weakness, it might have been ignored, especially if enzyme levels were not elevated.
Drs. Redberg and Katz go on to put this all into perspective. They use a “decision aid” from the Mayo Clinic website to assess actual data on risks and benefits of statins:
“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, 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.”
The authors point out that when statins are used for primary prevention (people who may have elevated LDL cholesterol but have not had a heart attack or a diagnosis of heart disease) 244 patients would have to take a statin daily for five years in order to prevent one death. In other words, 243 of the 244 people on statins would not prolong their life by taking such medicine.
Statins and Mice:
A new experiment in mice found that animals given statin drugs to reduce their cholesterol had reduced grip strength and their leg muscles tired more quickly (PLOS One, Dec. 9, 2016). The mice receiving statins were less able to exercise. The authors note that “…two weeks of statin treatment can significantly impair muscle function, as evidenced by decreased running wheel activity…”
Statins, Muscle Pain and Weakness:
Human research has also linked statin use to muscle injury. It can occur without increases in creatine kinase. The damage can persist for a considerable time after the statins are discontinued (CMAJ, July 7, 2009).
If statins do indeed make it harder for some people to exercise, there is real concern about the benefits of these drugs. Fitness has been recognized as a critical component of heart health (Circulation, Dec. 13, 2016).
Doctors and patients may need to negotiate the most appropriate strategies to prevent heart disease. For many, statins are beneficial and do not cause complications. For others, side effects such as elevated blood sugar or decreased ability to exercise may make statins less useful. Other approaches might be more helpful.
Our Guide to Cholesterol Control and Heart Health offers a variety of other tactics that may help in the fight against heart disease. Anyone who would like a copy, please send $3 in check or money order with a long (no. 10) stamped (68 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.
