Researchers identify strategies to optimize statin treatment for muscle symptoms

August 28, 2017, The Mount Sinai Hospital

Statins are highly effective for preventing heart attacks by reducing low-density lipoprotein or "bad" cholesterol. However, 10 to 20 percent of patients taking statins report muscle-related symptoms including aches, pains and cramps that prevent the use of recommended doses. Patients who have difficulty taking statins have a high risk of cardiovascular events, resulting in higher health care costs.

To address these concerns, Mount Sinai researchers are providing approaches to optimize cardiovascular risk reduction for these patients. The findings will be published in Journal of the American College of Cardiology on Monday, August 28, at 2 pm.

Since adverse symptoms are subjective, the research team developed a -associated muscle symptom (SAMS) clinical index to evaluate whether the symptoms are consistent with statin-associated muscle symptoms. A low score identifies patients with a very low likelihood that the muscle symptoms are truly due to the statin.

"Muscle symptoms experienced by patients on may or not be related to the medication," said the study's lead author, Robert Rosenson, MD, Professor of Medicine and Director of Cardiometabolic Disorders at the Icahn School of Medicine at Mount Sinai. "A different statin may be well tolerated in patients who were unable to tolerate a particular statin."

Rosenson and the research team propose the following strategies for optimizing cholesterol treatment in patients with SAMS:

  • Re-challenging as well as switching statins—While switching statins and reducing doses are commonplace, re-challenging patients with the same statin at the same dose is unusual because patients often feel uncomfortable retrying a statin that they perceive has caused intolerable effects. The research team advises clinicians to try the same statin at the same dose again to verify that the muscle symptoms occur again. In patients who have true statin muscle symptoms, other statins may be tolerated because they will experience fewer drug interactions or they have a genetic predisposition that results in more effective metabolism of an alternative statin.
  • Adopting healthy lifestyle changes. Eating a healthy diet, maintaining a normal weight, exercising regularly, and avoiding tobacco will help patients lower their LDL cholesterol, which may allow them to take reduced statin doses.
  • Non-statin pharmacotherapies. Taking ezetimibe (Zetia) before a PCSK9 inhibitor, a different class of cholesterol-busting drugs, bile acid sequestrants (BAS), or fibric acid medications can also lower LDL cholesterol; these drugs are not linked to adverse muscle complaints.
  • Nutraceuticals. Coenzyme Q10 may reduce SAMS, and ingesting turmeric can improve pain in patients with musculoskeletal conditions. Additional trials are needed to evaluate these therapies.
  • Evaluation for other diseases affecting the musculoskeletal system.

Explore further: Benefits of continued statin use after adverse reactions

More information: Journal of the American College of Cardiology (2017). DOI: 10.1016/j.jacc.2017.07.752

Related Stories

Benefits of continued statin use after adverse reactions

July 24, 2017
Statins are known to reduce the risk of death and cardiovascular events for people who are at high risk; however, as many as 75 percent of patients discontinue statin therapy within two years, often after reporting an adverse ...

Quitting statins after stroke may raise risk of another stroke

August 2, 2017
Stroke patients who stopped taking statin drugs three to six months after a first ischemic stroke, the type caused by narrowed arteries, had a higher risk of a having another stroke within a year, according to new research ...

Statin intolerance objectively identified in patients

April 3, 2016
In the first major trial of its kind, Cleveland Clinic researchers used a blinded rechallenge with atorvastatin or placebo to objectively confirm the presence of muscle-related symptoms in patients with a history of intolerance ...

Continuing statin after adverse Rx tied to lower cardiac risk

July 25, 2017
(HealthDay)—For patients with an adverse reaction to a statin, continued statin prescriptions are associated with lower incidence of cardiovascular events and death, according to a study published online July 25 in the ...

Statins don't cause muscle pain: study

May 3, 2017
Cholesterol-lowering statin drugs may have been wrongly blamed for muscle pain and weakness, said a study Wednesday that pointed the finger at a psychological phenomenon called the "nocebo" effect.

Adherence to high-intensity statin drops-off for many following heart attack

April 19, 2017
A substantial proportion of patients prescribed high-intensity statins following hospitalization for a heart attack did not continue taking this medication with high adherence at two years after discharge, according to a ...

Recommended for you

Heart researchers develop a new, promising imaging technique for cardiac arrhythmias

February 22, 2018
Every five minutes in Germany alone, a person dies of sudden cardiac arrest or fibrillation, the most common cause of death worldwide. This is partly due to the fact that doctors still do not fully understand exactly what ...

Scientists use color-coded tags to discover how heart cells develop

February 22, 2018
UCLA researchers used fluorescent colored proteins to trace how cardiomyocytes—cells in heart muscle that enable it to pump blood—are produced in mouse embryos. The findings could eventually lead to methods for regenerating ...

Beetroot juice supplements may help certain heart failure patients

February 22, 2018
Beetroot juice supplements may help enhance exercise capacity in patients with heart failure, according to a new proof-of-concept study. Exercise capacity is a key factor linked to these patients' quality of life and even ...

'Beetroot pill' could help save patients from kidney failure after heart X-ray

February 22, 2018
Beetroot may reduce the risk of kidney failure in patients having a heart x-ray, according to research led by Queen Mary University of London.

Women once considered low risk for heart disease show evidence of previous heart attack scars

February 20, 2018
Women who complain about chest pain often are reassured by their doctors that there is no reason to worry because their angiograms show that the women don't have blockages in the major heart arteries, a primary cause of heart ...

Can your cardiac device be hacked?

February 20, 2018
Medical devices, including cardiovascular implantable electronic devices could be at risk for hacking. In a paper publishing online today in the Journal of the American College of Cardiology, the American College of Cardiology's ...

1 comment

Adjust slider to filter visible comments by rank

Display comments: newest first

t2dm2
not rated yet Aug 29, 2017
Great to see CoQ10 mentioned as statins lower CoQ10 levels and CoQ10 may help improve muscle pain caused by statins.

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.