A friend states that he runs 3 to 4 times a week and lifts weights three times a week. Afterwards, he reports that he is very sore. He said that he had always assumed that the soreness was due to the fact that he is 64 years old. But he recently read an article about statins causing muscle pain and possibly causing muscle damage. (1)
His question is: Is my cholesterol medicine (a statin) causing the muscle soreness?
The short answer is yes, probably. (2,3)
So, what should he do?
My suggestions to him were:
First, check your Free T4 and TSH (thyroid blood tests) as hypothyroidism exacerbates muscle pain occuring in patients taking statins.
Second, get a serum vitamin D level as a low serum vitamin D can make statin related muscle symptoms worse.
Third, check the creatine kinase (CK) blood level. CK is an enzyme that is elevated in the blood when there is muscle damage. However, it is important to note that even with a normal CK your muscle symptom(s) is (are) still most likely due to the statin medicine you are taking. The purpose of getting a CK blood level with muscle symptom(s) is to make sure you don’t have a markedly elevated CK which can mean that there is a danger of rhabdomyolysis (a rare but serious side effect of statins).
Remember, you can order your own lab tests on line without a doctor’s order. (4)
But most likely all the above blood tests will be normal. But even with normal blood tests, it is likely that the statin (cholesterol lowering medicine) is causing his muscle pain.
So, again, what should my friend do?
Well, the purpose of taking the statin medicine is to lower the person risk of heart attack, heart attack death, or stroke. So the person needs to decide whether the lower risk from taking the cholesterol medicine is worth the muscle pain that he is experiencing.
First, what is his risk without taking the cholesterol medicine. The way to decide that is to calculate a risk profile. (5) The article referenced tells you how to do this.
A person will find out that he is estimated to be at high risk (greater than 20% risk of heart attack or heart attack death over the next 10 years), intermediate risk (10 to 20% risk), or low risk (less than a 10% chance of heart attack or heart attck death over the next ten years).
Then what is the risk reduction by taking the statin cholesterol medicine. You will get various estimates but a 25% risk reduction is a reasonable number.
That means that if you have a 20% risk of heart attack or heart attack death before taking the cholesterol medicine, then on the medicine you will have a 15% risk (25% of 20% is 15%).
So over the next ten years 20 people (not taking the statin) at that risk level will have a bad outcome (heart attack or heart attack death) and 80 people (not taking a statin) will be okay.
And over the next ten years at that risk level, 15 people (who are taking a statin) will have a bad outcome and 85 people (taking the statin) will be okay.
Therefore, the person taking the medicine has to decide for him or herself wether the benefit in risk reduction is worth a side effect of a medicine. The doctor can’t decide for you.
But know that any preventive medicine has only limited preventive power. So if the medicine is making you miserable it may not be worth the benefit. You have to decide.
(1) Do Statins Make It Tough to Exercise available at
https://well.blogs.nytimes.com/2012/03/14/do-statins-make-it-tough-to-exercise/.
(2) Statin-Associated Muscle-Related Adverse Effects: A Case Series of 354 Patients. Pharmacotherapy, 2010 available at https://onlinelibrary.wiley.com/doi/10.1592/phco.30.6.541/abstract.
(3) Association between statin-associated myopathy and skeletal muscle damage. CMAJ, 2009 available at https://www.ecmaj.ca/content/181/1-2/E11.full.pdf.
(4) Order Your Own Blood Tests On the Internet available at https://www.tomwademd.net/2012/02/21/order-your-own-blood-tests-on-the-internet/.
(5) Are You At High Risk of Heart Attack Due to Your Past Medical History available at
https://www.tomwademd.net/2012/02/09/are-you-at-high-risk-of-heart-attack-due-to-your-past-medical-history/.
