Statin Muscle Toxicity

Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.

Last week, February 28, 2012, the FDA announced newly mandated safety labeling for cholesterol-lowering statin drugs—such as Lipitor, Mevacor, Crestor, Zocor, and Vytorin. The FDA issued new side effect warnings regarding the increased risk of brain-related side effects, such as memory loss and confusion, an increase in blood sugar levels, and risk of new onset diabetes associated with taking this class of drugs.  

One prominent cardiologist described the Faustian bargain to the Wall Street Journal. Apparently, “1 to 2 out of 100 patients at risk for a heart attack will avoid one” by taking statins. But research now suggests for every 200 people taking a statin, 1 will develop diabetes.  

Wouldn’t it be great if there were some way to lower the risk of heart attacks and diabetes at the same time?

First, let me address the third side effect newly addressed by the FDA: the risk of muscle injury. We’ve known that about 1% to 5% of patients suffer enough muscle damage to cause pain and overt weakness, but only about 1 in 6,000,000 or 7,000,000 actually suffers enough muscle damage to kill them. It’s called fatal rhabdomyolysis, where your muscles break down so rapidly your urine starts looking like this, as you literally start peeing your muscles down the toilet. Then your kidneys fail, and you die.

But that’s like winning the lottery chances. There’s a 1 in 2 chance we’ll die of heart disease—so, no surprise Lipitor is the #1 prescribed drug on the planet Earth. 

But then, this study was published. Normally, if you have muscle pain on a statin, you go to a doctor, and they take blood to see if you have elevated levels of muscle breakdown products in your bloodstream. Now if you don’t, they basically say, oh, it’s all in your head—go home, keep taking your medicine.

What these researchers did, though, was they instead took these people, and got muscle biopsies, and proved that even though their blood levels were normal, they were indeed suffering muscle damage. The damage just wasn’t leaking into their bloodstream. Well, if that’s the case, if you can’t pick it up with the test, maybe everyone taking statins is suffering muscle damage—whether they’re experiencing pain or not.

And that’s exactly what they found. Clear evidence of skeletal muscle damage in statin-treated patients—all statin-treated patients. This is what a muscle is supposed to look like under a microscope. This is your muscle; this is your muscle on statin drugs.

But, the degree of overall damage was slight. Most people don’t even feel any pain with statins, so what’s the big deal?

This is the big deal. New study on statin therapy, muscle function, and falls risk. Hundreds of older men and women followed for a few years, and those who were on statins suffered greater declines in muscle strength and muscle quality, and greater increases in falls risk.

So we don’t want to be taking this drug unless we really need it. The problem is, because heart disease remains our #1 killer, most everyone does need to take a statin drug like Lipitor every day for the rest of our lives—except for one group. This is from the editor-in-chief of the American Journal of Cardiology: “Only pure vegetarians for practical purposes do not need statins. Most of the rest of us do!” So, it’s our choice.

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• Draeger A, Monastyrskaya K, Mohaupt M, Hoppeler H, Savolainen H, Allemann C, Babiychuk EB. Statin therapy induces ultrastructural damage in skeletal muscle in patients without myalgia. J Pathol. 2006 Sep;210(1):94-102
• Scott D, Blizzard L, Fell J, Jones G. Statin therapy, muscle function and falls risk in community-dwelling older adults. QJM. 2009 Sep;102(9):625-33.
• Mohaupt MG, Karas RH, Babiychuk EB, Sanchez-Freire V, Monastyrskaya K, Iyer L, Hoppeler H, Breil F, Draeger A. Association between statin-associated myopathy and skeletal muscle damage. CMAJ. 2009 Jul 7;181(1-2):E11-8.
• U.S. Food and Drug Administration. FDA announces safety changes in labeling for some cholesterol-lowering drugs. Feb. 28, 2012.
• Roberts WC. Evaluating lipid-lowering trials in the twenty-first century. Am J Cardiol. 2009 May 1;103(9):1325-8

Image thanks to The Scripps Research Institute

• cardiovascular disease
• cholesterol
• kidney failure
• Lipitor
• liver health
• liver inflammation
• medications
• mortality
• muscle health
• muscle strength
• pain
• statins