Statins Don’t Cause All the Muscle Pain They’re Blamed For

Statins are a class of cholesterol-lowering drugs that are commonly prescribed and likely save a lot of lives. They’re also notorious for being able to cause muscle pain, which leads many people to quit their statins or be hesitant about taking one in the first place. But a new study suggests that most of the muscle pain people get on statins doesn’t come from the statins at all.

The study aimed to calculate how many people get muscle pain from statins, not just while they were on statins. Because, of course, muscle pain can come from other sources. You can be sore after a day at the gym, after spending all day raking your yard, or have muscle aches from the flu. A variety of medical conditions can also cause muscle pain too, including fibromyalgia, lupus, and lyme disease. Other medications besides statins may also be the culprit.

The new meta-analysis looked at large, randomised statin studies that were placebo controlled. (One group of patients got a statin, while another group did not.) If statins commonly caused muscle pain, we would expect to see more people with muscle pain in the statin groups than the corresponding control groups. But the researchers found that muscle pain, cramps, and related symptoms were common in both groups, and that people on statins were only slightly more likely to report those symptoms than those in the placebo groups. They calculated that, of people who are on statins and experience muscle pain, at least 90% would have still had the muscle pain if they weren’t taking the statin.

Importantly, they also found that people who do get muscle pain because of statins tend to experience that side effect in the first year of taking the drug. So if you’ve been on a statin for five years and are only just now experiencing muscle pain, chances are pretty good that the statin isn’t causing it. They also found that the muscle pain caused by statins isn’t more severe than other types of muscle pain.

There currently aren’t guidelines for what to do if somebody on statins does experience muscle pain; the authors suggest that the field needs better recommendations on how to handle that situation. A person who gets muscle pain may want to consider stopping their statin, but they may also benefit from investigating the source of the pain, in case it’s something else that requires medical attention.

Ultimately, it comes down to risks versus benefits. The authors of the study calculated that of every 1,000 people who start a statin and see their LDL cholesterol drop by 1 millimole per litre in five years, statins “might cause 11 (generally mild) episodes of muscle pain or weakness, but prevent 50 major vascular events in those with pre-existing vascular disease (secondary prevention), and 25 major vascular events in those without pre-existing vascular disease (primary prevention).”

Ultimately, whether you take a statin should be a decision you make with your doctor. But if muscle pain has been your main reason for feeling hesitant about taking one, the new data may help you make a more informed decision.