Effect of Statins on Skeletal Muscle Function

Abstract

Background Many clinicians believe that statins cause muscle pain, but this has not been observed in clinical trials and the effect of statins on muscle performance has not been carefully studied. Methods and Results The Effect of STatins On Skeletal Muscle Function and Performance (STOMP) study assessed symptoms and measured creatine kinase (CK), exercise capacity, and muscle strength before and after atorvastatin 80 mg or placebo were administered for 6 months to 420 healthy, statin-naive subjects. No individual CK value exceeded 10 times normal, but average CK increased 20.8 ± 141.1 U/L (p<0.0001) with atorvastatin. There were no significant changes in several measures of muscle strength or exercise capacity with atorvastatin, but more atorvastatin than placebo subjects developed myalgia (19 vs 10; p = 0.05). Myalgic subjects on atorvastatin or placebo decreased muscle strength in 5 of 14 and 4 of 14 variables respectively (p = 0.69). Conclusions These results indicate that high-dose atorvastatin for 6 months does not decrease average muscle strength or exercise performance in healthy, previously untreated subjects. Nevertheless, this blinded, controlled trial confirms the undocumented impression that statins increase muscle complaints. Atorvastatin also increased average CK suggesting that statins produce mild muscle injury even among asymptomatic subjects. This increase in CK should prompt studies examining the effects of more prolonged, high-dose statin treatment on muscular performance. Clinical Trial Registration Information: www.clinicaltrials.gov; Identifier: NCT00609063.

Statins and Physical Activity in Older Men

“…16 While short-term studies suggest that statins decrease physical activity in older adults for up to one year, it was unclear if this effect was sustained. 8,9 Our long-term study, that followed men up to an average of 6.9 years, suggests that statins are associated with less physical activity for as long as statins are used. In cross sectional analyses, statin users started with lower physical activity levels compared to nonusers.…”

“…5–7 If present, these symptoms are most often observed after initiation of statin therapy, and may cause a decline in physical activity. 8 Several short-term studies have suggested that prevalent use or initiation of a statin use is linked to less physical activity in older adults followed for up to a year. 8,9 Other studies have demonstrated that initiation of moderate physical activity increased muscle pain and symptoms in statin users.…”

“…8 Several short-term studies have suggested that prevalent use or initiation of a statin use is linked to less physical activity in older adults followed for up to a year. 8,9 Other studies have demonstrated that initiation of moderate physical activity increased muscle pain and symptoms in statin users. 9–11 Finally, a recent 12-week aerobic exercise study showed that cardiorespiratory fitness and respiratory markers in the muscles were improved for statin nonusers, but did not improve in patients randomized to 40 mg of simvastatin.…”

Statin-induced myalgia and myositis: an update on pathogenesis and clinical recommendations

“…It has been argued that these studies may be biased, as patients who had developed some type of muscle disease in the past were excluded. Supporting this concept, the prevalence of myalgia in observational studies is higher, close to 20% [8,16–18]. On the other hand, clinicians have to take into account the nocebo effect, meaning the negative expectations of the patient and their doctors regarding muscular manifestations attributed to statins.…”

Optimal strategies for monitoring lipid levels in patients at risk or with cardiovascular disease: a systematic review with statistical and cost-effectiveness modelling

“…237 Recent systematic reviews 238,246 found no increase in muscle problems in statin groups compared with placebo groups across randomised trials; however, two trials not included in those reviews did find such effects. 247,248 A recent overview commented that there were other possible effects of statins that did not have strong RCT evidence, such as the possible increase of cataracts. 249 An extreme scenario to consider would be to suggest universal treatment at highest tolerated dose, as the associated costs of overtreatment are very small in relation to the costs of undertreatment.…”