Fears about statin side effects: Often unfounded?

Are you hesitant to fill your statin prescription because you’re worried the drug will cause muscle aches and other side effects? Although you’re far from alone (see “A royal pain?”), the reality is that all drugs have side effects, and statins aren’t worse than other drugs. And fears about statin side effects may be depriving people of a potentially lifesaving medication.

The nocebo effect — the flip side of the well-known placebo effect — occurs when people experience negative effects from a drug, placebo, or other treatment based on an expectation of harm. Because of the widespread belief that statins cause muscle aches, statins have been suspected of triggering a strong nocebo effect. A recent study confirmed this observation (see “A study to assess statin side effects”).

“The results reaffirm what doctors have long observed: the muscle aches people complain about when they take a statin are not necessarily due to the medication,” says Dr. Christopher Cannon, professor of medicine at Harvard Medical School. Some muscle aches can be attributed to the nocebo effect, which has been documented in several other studies, he notes. Another possibility: When doctors prescribe statins, they also encourage other heart-healthy behaviors such as exercise. Starting a new workout routine can make your muscles sore, especially if you haven’t been exercising regularly.

A royal pain?In 2011, renowned epidemiologist Dr. Rory Collins was knighted for his scientific contributions, which include major studies on the causes and treatment of heart attacks. During the ceremony, when Sir Collins mentioned his work on statins, Prince Charles said, “Aren’t those the drugs that cause all those side effects?”

The real deal

To be clear, some muscle symptoms can be attributed to statins, although the incidence ranges between 5% and 10% of statin users. How can you tell if you’re in that minority? The statin may be causing the problem if the ache or pain

  • is recent: the ache or weakness begins within a month of starting the statin (those that arise after several months are less likely to be caused by a statin)
  • is symmetrical: the muscle problem affects both sides of the body (if the ache is in one leg, for example, it’s less likely to be from the statin)
  • is unexplained: there is no other obvious reason for the muscle ache or weakness, such as a new exercise regimen or an injury.
A study to assess statin side effectsBritish researchers devised a unique study that enrolled people who thought they couldn’t tolerate statins based on a previous negative experience with the drugs. They dubbed the study SAMSON, which stands for Self-Assessment Method for Statin Side-effects Or Nocebo. Their findings, published Nov. 26, 2020, in The New England Journal of Medicine, are detailed below.Who: 60 adults who had previously taken statins but stopped taking them because of side effects.How: All participants received 12 prescription drug bottles: four containing a month’s supply of atorvastatin; four with look-alike, inert pills; and four empty bottles. Over the following year, they used each bottle for one month according to a random sequence.What: Every day, participants used a smartphone app to record their symptoms, which they ranked on a scale of 0 (no symptoms) to 100 (worst imaginable).Key findings: During the no-pill (empty bottle) months, average symptom scores were 8.0. Average scores were about twice as high when participants took actual pills. But there was no significant difference in the average scores between the dummy pills (15.4) and the statin (16.3). Some people even reported worse symptoms on the fake pills than when they were on the real drug.By pooling the findings across all the participants, researchers concluded that 90% of the symptoms could be attributed to the nocebo effect (see main text). When the researchers told participants about the results, half of them successfully restarted a statin and were still taking it six months later.

DIY experiment

“When a patient reports muscle aches on a statin, I’ll often suggest this experiment: Stop the statin for a month, see how you feel, then restart the drug. If the symptoms return, we’ll know that’s what was causing the trouble,” says Dr. Cannon. Even among people who are affected, muscle-related symptoms usually resolve if they switch to a different statin, take a lower dose, or take the drug just three days a week. But don’t change your regimen unless you have your doctor’s permission, Dr. Cannon cautions.

Bible verses for today’s meditation and inspiration: Matthew E. McLaren

“If you, then, though you are evil, know how to give good gifts to your children, how much more will your Father in heaven give good gifts to those who ask him!” – Matthew 7:11

 “A cheerful heart is good medicine, but a crushed spirit dries up the bones.” – Proverbs 17:22

 “Do not be anxious about anything, but in every situation, by prayer and petition, with thanksgiving, present your requests to God.” – Philippians 4:6

 “Above all else, guard your heart, for everything you do flows from it.” – Proverbs 4:23

 “For God has not given us a spirit of fear, but of power and of love and of a sound mind.” – 2 Timothy 1:7

 “Consider it pure joy, my brothers and sisters,[a] whenever you face trials of many kinds, because you know that the testing of your faith produces perseverance.” – James 1:2-3

 “In all your ways acknowledge him, and he will make straight your paths.” – Proverbs 3:6

 “Commit your actions to the LORD, and your plans will succeed.”- Proverbs 16:3

 “Consider the ravens: They do not sow or reap, they have no storeroom or barn; yet God feeds them. And how much more valuable you are than birds!” Luke 12:24 – Luke 12:24

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