The main results of this study relate to the lipid-lowering effects of two alternative non-statin medications. However, it highlights the muscle-related adverse effects that can occur with statins.
The study is carefully designed and has many strengths, including:
- a washout period between drugs to remove any residual effects
- double-blind design throughout so people didn't know what they were taking
- sufficient duration for each phase of the study (10 and 24 weeks) to allow effects to develop
- a good sample size – the researchers calculated beforehand how many people would need to be recruited to enable them to reliably detect differences between the groups
There are some points to keep in mind, however.
This study isn't able to inform us of the overall incidence of muscle aches and pains when people take statins. A specific sample of people was recruited to the study, and they had already reported muscle problems when taking several statins previously.
It can then tell us that when these people took low-dose atorvastatin and placebo in a double-blinded manner, just under a half of them experienced these problems when taking the statin only. This suggests that these were effects definitely related to the statin.
However, that's not to say the remaining half had previously imagined these effects – they could have had effects with other statins or with higher doses than the 20mg taken here.
The muscle-related side effects of statins are already well known. Product literature notes side effects of muscle aches, pains and weakness, and the potential risk of developing the serious condition rhabdomyolysis. This is where muscle fibres are broken down and released into the bloodstream, which can damage the kidneys. Doctors are advised to use statins with caution in people with a history of muscle weakness or rhabdomyolysis.
Statins are highly effective and relatively safe drugs, and are the medication of first choice for lowering cholesterol. Ezetimibe is currently only recommended by the regulatory body NICE for people who cannot take a statin.
Evolocumab has only recently been licensed for the treatment of people who cannot take statins, or in combination with a statin if a statin alone is ineffective at reducing cholesterol.
NICE issued draft guidance at the end of last year that did not recommend this drug if other lipid-lowering treatments could be taken. However, the final version of the guidance, which may say something different, is expected some time this year.
People should continue to take their statins as prescribed, but anyone with unexplained muscle aches and pains should report these to their doctor.
Often, lowering the dose or switching to an alternative type of statin can help prevent side effects. Lifestyle changes such as eating a healthy diet and taking regular exercise can also help lower your cholesterol.
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