Q&A With Heart Experts: In this series, heart specialists answer common questions about statins and heart health.
Do statins cause muscle and joint pain?
Many people who take statins may also experience muscle aches, but research shows the statin itself usually isn’t the cause. In very large double-blind trials comparing statins to placebo, about 27% of people on statin report muscle pain or weakness, but almost the same number – 26.6% of people taking placebo – did too, meaning muscle complaints were not caused by a statin. In the first year, statins caused only about 11 extra cases of muscle pain per 1,000 people per year compared with placebo, and after the first year there was no significant difference in muscle symptoms between statin and placebo groups. Overall, more than 90% of muscle symptoms were not due to the statin itself.
The SAMSON trial looked at why some people report muscle aches while taking statins. Participants took statins, placebo pills (sugar pills), or no pills in different months and recorded their daily symptoms. The study found that muscle aches were almost the same when taking statins or placebo (about 15-16 on a 0-100 scale) and were much lower when taking no pills at all. This shows that about 90% of the symptoms were felt in those expecting side effects.
What is the true risk of objective muscle injury (myopathy or rhabdomyolysis)?
Serious muscle injury from statins is very rare. Muscle problems with lab evidence (high creatine kinase or CK) happen in less than 1 in 1,000 people in large studies, and severe muscle breakdown that can hurt the kidneys (rhabdomyolysis) is even rarer – about 1 in 10,000 to 1 in 100,000 people. A very rare autoimmune reaction called HMGCR-antibody myopathy, which causes progressive weakness, occurs in about 2 in 100,000 to 1 in 1 million people taking statins. One statin, cerivastatin, was linked to rhabdomyolysis and has since been off the market. Most other statins – like atorvastatin, simvastatin, pravastatin, and rosuvastatin – rarely cause serious muscle injury and are still widely used.
Most people who notice muscle symptoms can still stay on statins. Importantly, when muscle symptoms are caused by a statin, they are reversible and typically go away within a few weeks once the medication is adjusted or stopped (Warden et al 2023).
Your health care team has several options to help you stay on therapy: lowering the dose, trying an alternative dosing schedule (such as every other day or a few times per week), switching to a lower-potency statin, or switching to a statin that is broken down by the body through a different pathway, which may be better tolerated (Joy & Brennan 2016; Warden et al 2023). Over 70% of people who were told they could not tolerate a statin are able to stay on one successfully when one of these strategies is used (Cheeley et al 2023).
Your care team will also check for other causes of muscle pain, like vitamin D deficiency, thyroid problems, or other medications.
Am I better off taking a statin or avoiding a statin?
For most people at risk of heart disease, the benefits of statins far outweigh the small risk of muscle symptoms. Statins lower the chance of heart attack, stroke, and death from heart disease. Most muscle symptoms are mild, temporary, and not caused by statins. Serious muscle injuries are very rare. If you do have muscle symptoms, your health care team can help you find a statin or dose that works for you. They can also suggest other cholesterol-lowering medicines if needed.
If you have questions or concerns about statins and muscle symptoms, talk to your care team. They can help you weigh the risks and benefits of your personal situation.
Key Points
- Muscle aches are common but typically aren’t caused by statins. Only a small number of people (1-2%) have symptoms that are truly linked to statins.
- Serious muscle problems from statins are very rare.
- Most people who experience side effects can keep taking statins safely by adjusting the dose or switching to a different one if needed.