Most people who take statins suffer no side effects from the cholesterol-lowering drugs. A small but significant number, however, develop mild to crushing muscle pain. In rare cases, the drugs can lead to permanent muscle damage, kidney problems, and death. Doctors disagree about the frequency of statin-induced muscle pain; clinical trials put the number at around 3 percent, though some doctors estimate that as many as 10 to 15 percent of statin patients are affected to some degree. Are you among them? Here are seven reasons not to dismiss the discomfort as a harmless symptom of age:
1. Your doctor might. There's evidence in the medical literature that patients on statins don't report any more muscle pain than those on a placebo, which causes many doctors to disregard any complaints. One 2007 study showed that when patients suggested a link between their pain and statin use, nearly half of doctors dismissed the possibility. Also, some hospitals offer financial incentives to doctors who keep their patients' cholesterol levels low, which encourages them to overlook side effects, says Beatrice Golomb, an associate professor of medicine at the University of California-San Diego School of Medicine and the lead investigator behind a research project that tracks the side effects of statins.
2. Mild pain might be just the beginning. "Every patient who starts statins should monitor mild muscle pain," says Ronald Krauss, an expert on cholesterol and senior scientist at Lawrence Berkeley National Laboratory. "The mild pain can lead to more severe damage down the line," he says. There's a blood test available that can determine the extent of muscle damage.
3. Slight prescription changes might solve the problem. As my colleague Avery Comarow has reported, taking a lower dose or an alternative brand can make all the difference.
4. For some patients, the benefits of statins may not outweigh the risks. Though there's strong evidence that middle-aged men at a high risk of heart problems—who have diabetes, for example—survive longer on a statin, the evidence is hardly as robust for other patient populations, most notably women. Other risk factors that people should weigh in deciding on treatment: age, smoking history, blood pressure, HDL levels, and a family history of early heart disease.
5. You may have a genetic predisposition to statin-related side effects. There's growing understanding that specific genetic variants put people at a high risk of developing statin-induced side effects. Just today, researchers published a study in the New England Journal of Medicine that shows a strong link between a genetic variant called SLCO1B1 and adverse effects associated with simvastatin (Zocor). It's already known that statin intolerance tends to run in families. In the future, research such as this will likely allow doctors to tailor treatment more effectively.
6. There's quality of life to consider. For some people, statins can take a real toll on quality of life. Not being able to walk down the stairs without pain, say, or participate in cherished hobbies can put people experiencing strong adverse effects of statins into quite a funk that can lead to depression or other health problems. Athletes, for example, have a particularly hard time adjusting to statins, says Golomb. Some decide that reducing their heart risk isn't worth a diminished quality of life, she notes.
7. There are alternatives to statins. Statins can dramatically decrease cholesterol levels, but they're not the only option. Lifestyle changes, including the right diet, exercise regime, and dietary supplements, can also reduce LDL cholesterol levels.