Study finds severe muscle harms from statins are rare

Serious muscle complications tied to statins appear to be far less common than many patients fear, according to research published Thursday in The Lancet Digital Health. The finding matters because fear of side effects can keep people from taking cholesterol-lowering drugs that reduce the risk of heart attack and stroke.

The study, led by British researchers, used medical records from nearly 6 million adults in the United Kingdom to build a tool doctors can use to estimate a patient’s risk of muscle-related side effects while taking statins. The researchers found that about 0.04% of people had a 10-year risk above 10% for serious statin-related muscle disorders.

Those disorders include myopathy, a broad category of muscle disease that can cause weakness, soreness and fatigue; myalgia, or muscle pain; and rhabdomyolysis, a dangerous breakdown of muscle tissue that can release toxins into the bloodstream. Rhabdomyolysis can be fatal.

The new estimate is lower than figures cited in an American Heart Association report, which put myopathy below 1% and rhabdomyolysis below 0.1%. Dr. Bart Duell, a professor of medicine at Oregon Health and Science University who helped write that AHA report but was not involved in the new study, said the risk is small enough that it should not keep appropriate patients from using statins.

Fear persists despite long safety record

Statins, including atorvastatin, rosuvastatin and simvastatin, are among the most commonly prescribed and studied medicines. They can lower LDL cholesterol by as much as 60%, according to federal medical information cited in the report, and lower the risk of heart attack and stroke.

Even so, use remains limited among people who could benefit. Published research has found that fewer than half of roughly 50 million people in the United States who may benefit from statins take them, and up to one-third of patients do not fill prescriptions. Other research has found that about 40% of people prescribed a statin stop within three months.

Dr. Nishant Shah, a preventive cardiologist at Duke Health who was not involved in the new research, said public concern is driven by social media posts, non-peer-reviewed websites, word of mouth and family stories about possible side effects. Study co-author Ting Cai, a research fellow at the University of Oxford’s Nuffield Department of Primary Care Health Sciences, said statin side effects receive more attention than side effects from many other medicines.

Clinical trials have found that people taking statins report mild muscle pain slightly more often than people taking a placebo. In most of those cases, however, the pain was attributed to causes other than the drug.

Tool aims to personalize risk

Cai said the new calculator is meant for use during medical appointments, giving clinicians a way to discuss a patient’s personal risk based on factors such as age, lifestyle and other health conditions. Her team separated mild muscle symptoms from more serious outcomes such as myalgia and rhabdomyolysis.

Other risk tools already exist. The American College of Cardiology offers a calculator for clinicians to assess possible statin intolerance by drug and dose.

Doctors cited in the report said some patients do have a higher chance of side effects, including people with kidney disease and those taking certain medications. Dr. Steve Nissen of the Cleveland Clinic said vitamin D deficiency can also contribute to muscle soreness in people taking statins. Nissen consults for several statin manufacturers but receives no financial compensation, according to the report.

Duell said patients who develop symptoms should contact their doctor rather than stop treatment on their own. Doctors can lower the dose, pause the drug to see whether symptoms resolve, or consider other cholesterol-lowering medicines.

This story draws on original reporting from NBC News.