What is statin-induced myopathy?

High cholesterol can block your blood vessels and is one of the main risk factors for heart disease.

If your doctor confirms a high cholesterol diagnosis, they may prescribe statins to help manage your cholesterol levels.

While statins are well known for their cholesterol-lowering effects, some research links long-term statin use with myopathy.

Read on to find out what research says about the link between statins and myopathy.

What is myopathy? 

Myopathy refers to a group of diseases that cause muscle weakness and dysfunction. Myopathy typically affects the skeletal muscles.

You may receive a myopathy diagnosis at birth or develop the condition later in life.

Myopathy symptoms vary widely but can include breathing or mobility issues that affect day-to-day activities.

What are statins?

Statins are medications that help manage blood cholesterol levels.

They work by inhibiting the enzyme responsible for the formation of cholesterol in the liver.

Doctors may prescribe the following statins to control high cholesterol:

• simvastatin (Zocor)
• atorvastatin (Lipitor)
• fluvastatin (Lescol)
• lovastatin (Altoprev)
• pravastatin (Pravachol)
• rosuvastatin (Crestor)

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Can statins cause myopathy?

Research is mixed on the link between statins and myopathy, but some studies point to an association between the two.

One 2019 lab study involving both human and rat muscle suggests that statins may cause myopathy. The researchers found that statins can trigger the release of calcium from the muscles, which increases the risk of symptoms like muscle pain and weakness.

Additionally, authors of a 2021 research review reported that statins can interfere with muscle protein growth and coenzyme Q10, a protein responsible for producing muscular energy.

However, other studies have shown no significant association between statins and myopathy.

In a 2022 study published in the journal Lancet, researchers administered rosuvastatin to participants and followed up with them for 4 years. They found that during the first year, only 7% of participants reported symptoms suggestive of myopathy. After the second year, there were no noticeable complaints of muscle pain or weakness.

Based on these mixed findings, it may be possible that myopathy risk varies from person to person.

Contact your doctor if you notice myopathy-related symptoms, like muscle pain or weakness, while taking statins.

Common side effects of statins

People respond differently to statins.

Here are some possible statin side effects:

• mental confusion
• memory loss
• nerve damage
• poor blood sugar management
• headache
• dizziness
• nausea
• fatigue
• sleep problems

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Rare statin side effects

In rare cases, people can experience the following serious side effects when taking statins:

• liver damage
• kidney failure
• hemorrhagic stroke
• rhabdomyolysis, which occurs when damaged muscle tissue releases proteins or electrolytes into the bloodstream

Ways to manage statin-induced myopathy

If you experience muscle weakness that may be statin-related, talk with your prescribing doctor. Do not stop taking statins or make any changes to your statin dosage before talking with your healthcare professional.

Your doctor will take steps to determine if the myopathy is a statin-related side effect. This may include blood tests to rule out other possible causes or serious side effects, including complications from muscle damage.

Steps your prescribing physician may recommend and supervise to help manage muscle weakness due to statins include:

• stopping the statin for a brief period to determine if the myopathy is related to statin use
• reducing the dose of statin
• taking a supplement of coenzyme Q10, an antioxidant that has been shown to reduce muscle symptoms associated with statins

Your physician can discuss the benefits and risks of statins, including myopathy as a side effect. Together, you can work to find the right cholesterol treatment plan for you.

Alternatives to statins for high cholesterol

Statins are not right for everyone. An alternative medication for people who cannot tolerate the effects of statins is bempedoic acid.

A 2023 study involving almost 14,000 people showed that bempedoic acid reduced blood levels of low-density lipoprotein (LDL), also known as bad cholesterol, in participants who were unable to take or simply refused statin treatment.

Other medications that can help treat high cholesterol include:

• bile acid-binding resins like cholestyramine (Questran)
• fibrates, such as fenofibrate (Tricor)

The following lifestyle adjustments can help you manage high cholesterol:

• Eating a heart-healthy diet: Avoiding foods high in trans or saturated fat can help decrease blood cholesterol levels. Need help adjusting your diet? Consider talking with a healthcare professional like a dietitian who can help you create a heart-healthy eating plan.
• Quitting smoking if you smoke: Smoking can affect your overall health. Quitting may help regulate your blood cholesterol levels.
• Staying physically active: Engaging in frequent physical activity like exercising can help promote heart health and slowly decrease blood cholesterol levels.

Summary

Myopathy refers to a group of muscle diseases that cause muscle weakness, pain, and dysfunction.

Evidence on whether statins can lead to myopathy is mixed. But some research suggests a link between statin use and myopathy.

If you experience any unpleasant side effects while taking statins for high cholesterol, talk with a healthcare professional. They can recommend alternative medications to help manage your cholesterol.

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