Last week, I discussed the benefits of statin therapy in folks without known heart disease. I tried to put the statistics in perspective and concluded that the benefit was quite low. The next question to ask is “what  are the risks or side effects of this therapy?” Comparing benefits to risks, you can then make an informed decision.

Today, I’ll cover the most common risk/side effect which is muscle pain and even damage. Statins have been demonstrated to reduce CoQ10, a critical enzyme for mitochondrial function. This has been thoroughly studied in patients on statins and can lead to reduced cell energy, increased oxidation and cell death. The resultant pain can be severe leading to reduced activity and quality of life. Studies have reported the incidence of muscle pain as anywhere from 5% to 20%. In my practice it’s very common, perhaps closer to the higher number.  Granted, many patients are anticipating pain which increases it’s incidence as shown in placebo controlled trials. Bottom line: muscle pain is far more common and troublesome than reported in initial trials.

More concerning but fortunately less common is muscle damage or rhabdomyolysis in which the muscle cells break down in large number. This can result in kidney failure and other serious complications. For this reason, muscle pain when on statins should be quickly evaluated by a physician. This outcome is increased by higher doses, the presence of certain other drugs, multiple drugs given together and grapefruit juice. It’s also increased in pre-diabetic patients (the most common group given statins for prevention).

Finally, and perhaps most concerning to me is that statins and exercise do not mix. Competitive athletes usually cannot tolerate them. A study from June 2013 in JAMA: Internal Medicine showed a 19% increase in musculoskeletal injury in exercisers. More concerning is a study in The Journal of the American College of Cardiology from 8/13. It involved a 3 month exercise program in which half of the participants were placed on a statin. CV fitness increased by more than 10% in the non-statin group and only 1.5% in the statin group. Mitochondrial enzymes which typically raise with exercise rose >13% in the non-drug group compared to a drop of 4.5% in the drug group. More studies are needed. It seems likely that statins wipe out many if not most of the benefits of exercise.

Preventative medicine, as most everyone agrees, starts with behavior change. Exercise is a critical part of this. Do you really want to take a drug intended to prevent disease which reduces and maybe even eliminates the benefits of exercise? I didn’t think so! Consider a statin if you already have heart disease or a rare genetic defect in cholesterol production but not purely for prevention.

Next week, I’ll cover other side effects and share concluding thoughts on this crucial topic. Remember, for good health, be informed and partner with your doctor in these decisions.