[Santiagogirl]

Evaluating a common complaint (muscle pain or weakness) in a group where it is very prevalent (older adults) is tricky from the outset. I read the study you mention (Effect of statin therapy on muscle symptoms:an individual participant data meta-analysis of large-scale, randomized, double-blind trials. Cholesterol Trialists' collaboration. The Lancet. 08/29/22). Of note, several of the authors reported significant associations with the pharmaceutical industry. Results were a 7% overall increased rate ratio (RR) compared to placebo, for first reports of muscle pain or weakness in first year of statin therapy. The RR was higher at 9% for women, although digging through appendices of the article reveals RR of 14% in first year for women on low to moderate intensity statin therapy. Breaking down symptoms further, biggest overall difference was for muscle cramp or spasm (9%). More intensive statin therapy was associated with more muscle complaints, especially in the first year. Other factors associated with complaints of muscle pain were increasing body mass index,
increasing age, and race (Asians fared the worst). Statin therapy was associated with a small increase in muscle enzyme blood levels that was not considered clinically significant. (Although individuals with serious statin-related muscle damage including myopathy and rhabdomyolysis were excluded from all of these studies.) Most participants did not discontinue statin use during the study period, and reports of muscle symptoms decreased after first year of treatment. Take-home message appears to be that statins do cause relatively mild muscle complaints in at least 5-10% of people who start them, & severe symptoms including myopathy (1 in 10,000 person-years) and rhabdomyolysis (2-3 in 100,000 person-years) occur rarely. Supporting data in this study for a biological connection between statins and muscle complaints include small increases in measured muscle enzyme levels in the blood & an apparent dose-response relationship based upon level of treatment intensity. Given the established benefit of statin therapy on preventing bad cardiovascular outcomes & death, patients need to carefully weigh their individual risks versus benefits when deciding whether to start or continue treatment with statins.